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General NPI Number Information
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NPI Number | 1487170759
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Entity Type | Organization
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Legal Business Name | MY PEACE KEEPER II INC.
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Dates
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Enumeration Date | 08/18/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3119 SPRING GLEN RD STE 104
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City | JACKSONVILLE
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State | FL
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Zip | 32207-5921
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Country | US
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Telephone | 980-505-0902
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Fax | 704-919-5055
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Provider Business Mailing Address
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Address Line | 3119 SPRING GLEN RD STE 104
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City | JACKSONVILLE
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State | FL
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Zip | 32207-5921
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Country | US
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Telephone | 980-505-0902
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Fax | 704-919-5055
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Authorized Official
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Title or Position | DIRECTOR OF OPERATION
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Name | VIRGINIA POUGH
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Credential |
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Telephone | 980-505-0902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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