Provider Demographics
NPI:1508403247
Name:A PLACE OF PEACE 2LLC
Entity type:Organization
Organization Name:A PLACE OF PEACE 2LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANTAVIA
Authorized Official - Middle Name:LASHAY
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:386-898-4975
Mailing Address - Fax:
Practice Address - Street 1:1931 N WORTHINGTON DR
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-6143
Practice Address - Country:US
Practice Address - Phone:386-898-4975
Practice Address - Fax:383-259-9559
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A PLACE OF PEACE 2 LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-02
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No372500000XNursing Service Related ProvidersChore Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, ChildGroup - Single Specialty
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child