Healthcare Provider Details

I. General information

NPI: 1801165097
Provider Name (Legal Business Name): SIMPKINS SUPERIOR SUPPORT SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2011
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 SW 8TH ST UNIT B
HALLANDALE BEACH FL
33009-6737
US

IV. Provider business mailing address

PO BOX 567
HALLANDALE FL
33008-0567
US

V. Phone/Fax

Practice location:
  • Phone: 786-222-4180
  • Fax: 954-239-8894
Mailing address:
  • Phone: 786-222-4180
  • Fax: 954-239-8894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number003710800
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number003710800
License Number StateFL

VIII. Authorized Official

Name: MRS. LASONJA TERRELL SIMPKINS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 786-222-4180