Provider Demographics
NPI:1063439750
Name:PK HEALTH SERVICES LLC
Entity type:Organization
Organization Name:PK HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-376-2880
Mailing Address - Street 1:4113 LITTLE RD
Mailing Address - Street 2:UNIT 103
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1716
Mailing Address - Country:US
Mailing Address - Phone:727-376-2880
Mailing Address - Fax:727-816-9745
Practice Address - Street 1:4113 LITTLE RD
Practice Address - Street 2:UNIT 103
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-1716
Practice Address - Country:US
Practice Address - Phone:727-376-2880
Practice Address - Fax:727-816-9745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1163702363LP0808X
FLSW49951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAH351Medicare PIN