Provider Demographics
NPI:1578296182
Name:PRINCE OF PEACE EVANGELICAL LUTHERAN CHURCH OF PINELLAS COUNTY FL, INC
Entity type:Organization
Organization Name:PRINCE OF PEACE EVANGELICAL LUTHERAN CHURCH OF PINELLAS COUNTY FL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:IUSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-265-2609
Mailing Address - Street 1:455 MISSOURI AVE.
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-1561
Mailing Address - Country:US
Mailing Address - Phone:727-585-9969
Mailing Address - Fax:
Practice Address - Street 1:455 MISSOURI AVE.
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-1561
Practice Address - Country:US
Practice Address - Phone:727-585-9969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRINCE OF PEACE EVANGELICAL LUTHERA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-01
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care