Provider Demographics
NPI:1700616828
Name:SWEET PEAS PEDIATRIC CARE LLC
Entity type:Organization
Organization Name:SWEET PEAS PEDIATRIC CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-307-4544
Mailing Address - Street 1:306 TRACE HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-8765
Mailing Address - Country:US
Mailing Address - Phone:407-307-4544
Mailing Address - Fax:
Practice Address - Street 1:306 TRACE HARBOR RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-8765
Practice Address - Country:US
Practice Address - Phone:407-307-4544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health