Healthcare Provider Details

I. General information

NPI: 1861281248
Provider Name (Legal Business Name): PEGGY JOYCE HARGROVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2025
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3304 SAN MOISE PL
PLANT CITY FL
33567-1719
US

IV. Provider business mailing address

3001 VIA SIENA ST
PLANT CITY FL
33566-1000
US

V. Phone/Fax

Practice location:
  • Phone: 813-441-4231
  • Fax:
Mailing address:
  • Phone: 813-965-4490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State

VIII. Authorized Official

Name: PEGGY J HARGROVE
Title or Position: OWNER
Credential:
Phone: 813-965-4490