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General NPI Number Information
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NPI Number | 1851321087
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Entity Type | Organization
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Legal Business Name | HAVEN OF OUR LADY OF PEACE, INC.
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 01/04/2012
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Provider Practice Location Address
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Address Line | 1900 SUMMIT BLVD
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City | PENSACOLA
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State | FL
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Zip | 32503-3359
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Country | US
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Telephone | 850-436-5900
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Fax | 850-436-5959
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Provider Business Mailing Address
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Address Line | PO BOX 2728
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City | PENSACOLA
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State | FL
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Zip | 32513-2728
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Country | US
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Telephone | 850-416-7070
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Fax | 850-416-7453
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARTHA PEREZ
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Credential |
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Telephone | 850-436-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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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 | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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