Provider Demographics
NPI:1780242982
Name:FLORIDA KIDS PPEC, LLC
Entity type:Organization
Organization Name:FLORIDA KIDS PPEC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:M
Authorized Official - Last Name:ABDELLI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:850-960-5045
Mailing Address - Street 1:205 HARRISON PL
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4470
Mailing Address - Country:US
Mailing Address - Phone:850-960-5045
Mailing Address - Fax:
Practice Address - Street 1:5 E. LANE DR.
Practice Address - Street 2:UNITS A/B
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569
Practice Address - Country:US
Practice Address - Phone:850-226-8331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric