Healthcare Provider Details

I. General information

NPI: 1396202891
Provider Name (Legal Business Name): MS CONSULTING & SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2019
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 N RIDGE BLVD APT 522
CLERMONT FL
34711-2871
US

IV. Provider business mailing address

1290 N RIDGE BLVD APT 522
CLERMONT FL
34711-2871
US

V. Phone/Fax

Practice location:
  • Phone: 352-432-9910
  • Fax:
Mailing address:
  • Phone: 352-432-9910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MIRANDA N SMITH
Title or Position: OWNER
Credential:
Phone: 352-431-0929