Healthcare Provider Details

I. General information

NPI: 1851321087
Provider Name (Legal Business Name): HAVEN OF OUR LADY OF PEACE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 SUMMIT BLVD
PENSACOLA FL
32503-3359
US

IV. Provider business mailing address

PO BOX 2728
PENSACOLA FL
32513-2728
US

V. Phone/Fax

Practice location:
  • Phone: 850-436-5900
  • Fax: 850-436-5959
Mailing address:
  • Phone: 850-416-7070
  • Fax: 850-416-7453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MARTHA PEREZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 850-436-5900