Provider Demographics
NPI:1942987946
Name:PEACE LEADERS CARE CENTER CORP
Entity type:Organization
Organization Name:PEACE LEADERS CARE CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-643-3686
Mailing Address - Street 1:4801 S UNIVERSITY DR STE 251
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3836
Mailing Address - Country:US
Mailing Address - Phone:786-643-3686
Mailing Address - Fax:
Practice Address - Street 1:4801 S UNIVERSITY DR STE 251
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-3836
Practice Address - Country:US
Practice Address - Phone:786-643-3686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty