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General NPI Number Information
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NPI Number | 1902153927
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Entity Type | Organization
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Legal Business Name | CROWNE BUILDERS LLC
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Dates
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Enumeration Date | 08/08/2012
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Last Update Date | 08/08/2012
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Provider Practice Location Address
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Address Line | 164 CONCORD CIR
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City | PANAMA CITY
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State | FL
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Zip | 32405-3567
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Country | US
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Telephone | 850-596-8876
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Fax |
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Provider Business Mailing Address
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Address Line | 164 CONCORD CIR
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City | PANAMA CITY
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State | FL
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Zip | 32405-3567
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Country | US
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Telephone | 850-596-8876
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID MICHAEL PETERSON
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Credential |
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Telephone | 850-596-8876
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number | RR282811607
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License Number State | FL
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