Healthcare Provider Details

I. General information

NPI: 1750865945
Provider Name (Legal Business Name): A PLUS DEVELOPMENTAL SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6606 ROMILLY DR
JACKSONVILLE FL
32210-7139
US

IV. Provider business mailing address

6606 ROMILLY DR
JACKSONVILLE FL
32210-7139
US

V. Phone/Fax

Practice location:
  • Phone: 904-219-7791
  • Fax:
Mailing address:
  • Phone: 904-219-7791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: MS. LAQUANTA SHANKS
Title or Position: OWNER
Credential:
Phone: 904-219-7791