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General NPI Number Information
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NPI Number | 1194477679
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Entity Type | Organization
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Legal Business Name | PEASEO LIFE QUEST SOLUTIONS
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Dates
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Enumeration Date | 01/25/2022
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Last Update Date | 01/25/2022
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Provider Practice Location Address
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Address Line | 307 E 10TH AVE
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City | HAVANA
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State | FL
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Zip | 32333-1917
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Country | US
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Telephone | 850-570-0499
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Fax | 850-331-6655
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Provider Business Mailing Address
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Address Line | PO BOX 1136
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City | HAVANA
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State | FL
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Zip | 32333-1136
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Country | US
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Telephone | 850-570-0499
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Fax | 850-331-6655
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Authorized Official
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Title or Position | DIRECTOR
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Name | STEPHANIE ANN WILLIAMS
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Credential |
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Telephone | 850-570-0499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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