Healthcare Provider Details

I. General information

NPI: 1184133795
Provider Name (Legal Business Name): AHSAP SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 CORPORATE SQUARE BLVD
JACKSONVILLE FL
32216-0309
US

IV. Provider business mailing address

2121 CORPORATE SQUARE BLVD
JACKSONVILLE FL
32216-0309
US

V. Phone/Fax

Practice location:
  • Phone: 904-537-7875
  • Fax: 904-339-9674
Mailing address:
  • Phone: 904-537-7875
  • Fax: 904-339-9674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DIEDRE YOLANDA COLSON
Title or Position: OWNER
Credential:
Phone: 904-537-7875