Healthcare Provider Details

I. General information

NPI: 1023718194
Provider Name (Legal Business Name): PUZZLE PEACE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 TRAM RD
WHITEVILLE NC
28472-4359
US

IV. Provider business mailing address

PO BOX 1965
WHITEVILLE NC
28472-1965
US

V. Phone/Fax

Practice location:
  • Phone: 910-945-8939
  • Fax:
Mailing address:
  • Phone: 910-945-8938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. JAMEISHA SHONTA SPEARMAN
Title or Position: CEO
Credential:
Phone: 910-945-8938