Provider Demographics
NPI:1578101481
Name:SWEETIE PEETIE LLC
Entity Type:Organization
Organization Name:SWEETIE PEETIE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VIRGIL
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:904-553-8033
Mailing Address - Street 1:160 CYPRESS POINT PARKWAY
Mailing Address - Street 2:STE A108
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164
Mailing Address - Country:US
Mailing Address - Phone:386-283-4932
Mailing Address - Fax:
Practice Address - Street 1:160 CYPRESS POINT PARKWAY
Practice Address - Street 2:STE A108
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164
Practice Address - Country:US
Practice Address - Phone:386-283-4932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty