MEDICARE: COUNTYLINE SUPPORT SERVICES CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD1600X	Developmental Disabilities Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265911531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTYLINE SUPPORT SERVICES CORP

Provider Business Mailing Address
First Line	:	2114 N FLAMINGO RD # 166
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33028-3501
Country	:	US
Telephone Number	:	954-632-9891
Fax Number	:

Provider Business Practice Location Address
First Line	:	2114 N FLAMINGO RD # 166
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33028-3501
Country	:	US
Telephone Number	:	954-632-9891
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MAUVA ANGELA MUNFORD
Credential	:
Telephone Number	:	954-632-9891

Provider Enumeration Date	:	08/08/2018
Last Update Date	:	08/08/2018

Similar Medicare Providers

1457173981 — NATALIE MARIE GRILLO
Practice Location Address:

2114 N FLAMINGO RD # 1261
PEMBROKE PINES, FL
33028-3501

Practice Phone: 954-707-8095
Practice Fax:

1558384628 — DR. ALBERT C FERNANDEZ LCSW, PHD
Practice Location Address:

2114 N FLAMINGO RD STE 205
PEMBROKE PINES, FL
33028-3501

Practice Phone: 305-778-6381
Practice Fax: 954-885-0638

1477797553 — ELITE DIAGNOSTIX, INC.
Practice Location Address:

2114 N FLAMINGO RD , SUITE 166
PEMBROKE PINES, FL
33028-3501

Practice Phone: 954-662-7181
Practice Fax:

1376822353 — INFINITE LIFE MEDICAL LLC
Practice Location Address:

2126 N FLAMINGO RD
PEMBROKE PINES, FL
33028-3501

Practice Phone: 954-437-6660
Practice Fax: 954-450-2252

1023455615 — AMDA MEDICAL LLC
Practice Location Address:

2126 N FLAMINGO RD
PEMBROKE PINES, FL
33028-3501

Practice Phone: 954-437-6660
Practice Fax: 954-239-3902

1831510684 — MOTHER'S CARE DOULA SERVICES, INC.
Practice Location Address:

2114 N FLAMINGO RD STE 1261
PEMBROKE PINES, FL
33028-3501

Practice Phone: 954-433-2273
Practice Fax: 954-438-3732

Directions to “COUNTYLINE SUPPORT SERVICES CORP ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.