NPI:
1891206793
Provider Name:
PEACE CLUB INC.
Doing Business As: PEACE CLUB
Classification:
Clinic/Center - 261QR0405X
Entity Type:
Organization
Specialization: Rehabilitation, Substance Use Disorder
CLIA Number: 10D2157260
Address:
1811 S. ORLANDO AVENUE
COCOA BEACH, FL
ZIP 32931
Phone:
(321) 961-5833
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PEACE CLUB INC. is a rehabilitation and substance use disorder clinic center in Cocoa Beach, FL. PEACE CLUB INC. NPI is 1891206793. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Peace Club.
The provider's business location address is:
1811 S. ORLANDO AVENUE
COCOA BEACH, FL
ZIP 32931
Phone: (321) 961-5833
The provider's authorized official is Dennis Kolsch .
The authorized official title is Owner and has the following contact phone number (321) 420-4656.
The CLIA number assigned to this NPI record is 10D2157260 - other - subst. abuse outpat with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 10/18/2017 and was last updated on 1/24/2020.