# A PEACEFUL HOME OF LEWISTON

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- **Entity:** Organization
- **Status:** Active
- **Other names:** A Peaceful Home of Lewiston
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730843814
- **Authorized official:** MICHAEL BERRY ST JUSTE (PRESIDENT)
- **Authorized official phone:** (941) 536-6967

## Contact information

- **Practice address:** 22456 LEWISTON AVE, PORT CHARLOTTE, FL 33952-7172
- **Practice address phone:** (941) 536-6967
- **Practice address fax:** (941) 460-4387
- **Mailing address:** 2908 102ND AVE E, PARRISH, FL 34219-9203
- **Mailing address phone:** (941) 536-6967

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 10/26/2021
- **Last updated:** 10/26/2021