Provider Demographics
NPI:1235946617
Name:A PLACE OF PEACE 2 LLC
Entity type:Organization
Organization Name:A PLACE OF PEACE 2 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANTAVIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-898-4975
Mailing Address - Street 1:1931 N WORTHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-6143
Mailing Address - Country:US
Mailing Address - Phone:386-457-3207
Mailing Address - Fax:386-259-9559
Practice Address - Street 1:1640 GREGORY DR
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-6151
Practice Address - Country:US
Practice Address - Phone:386-898-4975
Practice Address - Fax:386-259-9559
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A PLACE OF PEACE 2LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances