Healthcare Provider Details

I. General information

NPI: 1518034719
Provider Name (Legal Business Name): CHANDLER SUPPORT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2142 HERSCHEL ST
JACKSONVILLE FL
32204-3820
US

IV. Provider business mailing address

2142 HERSCHEL ST
JACKSONVILLE FL
32204-3820
US

V. Phone/Fax

Practice location:
  • Phone: 904-477-4750
  • Fax: 904-381-9295
Mailing address:
  • Phone: 904-477-4750
  • Fax: 904-381-9295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. RYAN ANDREW CHANDLER
Title or Position: PRESIDENT
Credential:
Phone: 904-477-4750