Healthcare Provider Details

I. General information

NPI: 1942987946
Provider Name (Legal Business Name): PEACE LEADERS CARE CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 S UNIVERSITY DR STE 251
DAVIE FL
33328-3836
US

IV. Provider business mailing address

4801 S UNIVERSITY DR STE 251
DAVIE FL
33328-3836
US

V. Phone/Fax

Practice location:
  • Phone: 786-643-3686
  • Fax:
Mailing address:
  • Phone: 786-643-3686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALIDA CORTES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 786-643-3686