MEDICARE: PROFESSIONAL DISABILITY PROVIDER SERVICES, INC.

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	251C00000X	Developmentally Disabled Services Day Training Agency		FL

General Provider Information

NPI Number	:	1902927668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL DISABILITY PROVIDER SERVICES, INC.

Provider Business Mailing Address
First Line	:	6501 ARLINGTON EXPY
Second Line	:	SUITE #156-B
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-5779
Country	:	US
Telephone Number	:	904-727-0002
Fax Number	:	904-727-5070

Provider Business Practice Location Address
First Line	:	6501 ARLINGTON EXPY
Second Line	:	SUITE #156-B
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-5779
Country	:	US
Telephone Number	:	904-727-0002
Fax Number	:	904-727-5070

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. EVELYN L.. SHIPMAN
Credential	:
Telephone Number	:	904-727-0002

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	08/22/2020

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