Individual
PEGGY MARY GROGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1721 TIMBER EDGE DR, DELAND, FL 32724-7985
(386) 589-6313
(386) 626-2675
Mailing address
1721 TIMBER EDGE DR, DELAND, FL 32724-7985
(386) 589-6313
(386) 626-2675
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
12-12-010
FL
Other
Enumeration date
02/10/2022
Last updated
02/10/2022
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