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General NPI Number Information
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NPI Number | 1235946617
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Entity Type | Organization
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Legal Business Name | A PLACE OF PEACE 2 LLC
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Dates
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Enumeration Date | 12/18/2024
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 1640 GREGORY DR
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City | DELTONA
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State | FL
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Zip | 32738-6151
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Country | US
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Telephone | 386-898-4975
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Fax | 386-259-9559
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Provider Business Mailing Address
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Address Line | 1931 N WORTHINGTON DR
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City | DELTONA
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State | FL
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Zip | 32738-6143
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Country | US
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Telephone | 386-457-3207
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Fax | 386-259-9559
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Authorized Official
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Title or Position | OWNER
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Name | SHANTAVIA L COOPER
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Credential |
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Telephone | 386-898-4975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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