Peace in Young Life Center, Inc.

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

064010111 Issued in GA

Legal business name

PEACE IN YOUNG LIFE CENTER, INC.

Practice address

717 E Line St
Calhoun, GA 30701-2271

Phone

(706) 629-2212

Fax

(706) 629-2213

NPI assigned

Sep 25, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Marchelle Mitzi Gaines

Title

Ceo/Owner

Phone

(706) 263-2533

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Peace House2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Peace in Young Life Center, Inc.

  • Addiction (Substance Use Disorder) Counselor
  • Detroit, MI
  • NPI 1386826949
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Servilla V Harris, LCSW

  • Clinical Social Worker
  • Southfield, MI
  • NPI 1295867174
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329350400000",
    "number": "1447447362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "717 E LINE ST",
            "city": "CALHOUN",
            "state": "GA",
            "postal_code": "307012271",
            "telephone_number": "706-629-2212",
            "fax_number": "706-629-6613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "717 E LINE ST",
            "city": "CALHOUN",
            "state": "GA",
            "postal_code": "307012271",
            "telephone_number": "706-629-2212",
            "fax_number": "706-629-2213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACE IN YOUNG LIFE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-25",
        "last_updated": "2012-02-16",
        "status": "A",
        "authorized_official_last_name": "GAINES",
        "authorized_official_first_name": "MARCHELLE",
        "authorized_official_middle_name": "MITZI",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "706-263-2533"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "GA",
            "license": "064010111",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007422496A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Prachi Patel, PHARM.D
• Rina Dilip Patel
• Megan Patterson, M ED, CCC-SLP
• Holly D. Payne, CRNA
• Mai Lee Payne, OT
• Vincent Dirik Pearson, M.D.
• Ted M Pennel, M.D.
• Tiffany Nicole Pettiford
• Jessica Nicole Phillips, PT, DPT
• Physicians Spine and Rehab Specialists of Ga

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Calhoun, GA
• Providers in Calhoun, GA by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.