Provider Demographics
NPI:1720247448
Name:PETER PAN DAY CARE CENTER
Entity Type:Organization
Organization Name:PETER PAN DAY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF DEVELOPMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LUCIOUS
Authorized Official - Middle Name:CLARENCE
Authorized Official - Last Name:CONWAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:407-293-3492
Mailing Address - Street 1:1602 BRUTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-4230
Mailing Address - Country:US
Mailing Address - Phone:407-293-3492
Mailing Address - Fax:407-293-3492
Practice Address - Street 1:1602 BRUTON BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-4230
Practice Address - Country:US
Practice Address - Phone:407-293-3492
Practice Address - Fax:407-293-3492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency