1477000289 NPI number — PARENT SUPPORT, LLC

Table of content: (NPI 1477000289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477000289 NPI number — PARENT SUPPORT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARENT SUPPORT, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CARES TREATMENT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477000289
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3218 EAGLE WATCH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KISSIMMEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34746-3138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-901-4000
Provider Business Mailing Address Fax Number:
407-930-4830

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 TOWER CENTER BLVD
Provider Second Line Business Practice Location Address:
19TH FLOOR SUITE 1901
Provider Business Practice Location Address City Name:
EAST BRUNSWICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08816-1100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-901-4000
Provider Business Practice Location Address Fax Number:
407-930-4830
Provider Enumeration Date:
09/09/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SAMUEL
Authorized Official First Name:
VICKKI-ANN
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
407-901-4000

Provider Taxonomy Codes

  • Taxonomy code: 251300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)