Healthcare Provider Details

I. General information

NPI: 1295672392
Provider Name (Legal Business Name): FORD NATION SUPPORT SERVICES LIMITED LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 ALLENDALE DR
CLEARWATER FL
33760-1426
US

IV. Provider business mailing address

1855 ALLENDALE DR
CLEARWATER FL
33760-1426
US

V. Phone/Fax

Practice location:
  • Phone: 727-564-4179
  • Fax: 727-564-4179
Mailing address:
  • Phone: 727-564-4179
  • Fax: 727-564-4179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. PHILLIP FORD
Title or Position: CEO
Credential:
Phone: 727-564-4179