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General NPI Number Information
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NPI Number | 1811269327
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Entity Type | Organization
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Legal Business Name | PEISHWOOS INC
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Dates
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Enumeration Date | 01/30/2012
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Last Update Date | 01/30/2012
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Provider Practice Location Address
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Address Line | 8439 ROYAL PALM BLVD
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-5756
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Country | US
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Telephone | 954-854-3543
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Fax |
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Provider Business Mailing Address
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Address Line | 8439 ROYAL PALM BLVD
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-5756
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Country | US
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Telephone | 954-854-3543
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. WANDA E RUSSELL
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Credential |
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Telephone | 954-854-3543
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | MA0031292
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License Number State | FL
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