Provider Demographics
NPI:1811345358
Name:PEACE OF HEART COMMUNITY
Entity type:Organization
Organization Name:PEACE OF HEART COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-294-0209
Mailing Address - Street 1:3907 PONTE VEDRA BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-5832
Mailing Address - Country:US
Mailing Address - Phone:904-294-0209
Mailing Address - Fax:
Practice Address - Street 1:14 S ROSCOE BLVD
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-3812
Practice Address - Country:US
Practice Address - Phone:904-294-0209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities