Healthcare Provider Details

I. General information

NPI: 1912643719
Provider Name (Legal Business Name): FLEMING SUPPORT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2304 BURPEE DR W
JACKSONVILLE FL
32210-3739
US

IV. Provider business mailing address

2304 BURPEE DR W
JACKSONVILLE FL
32210-3739
US

V. Phone/Fax

Practice location:
  • Phone: 904-414-1211
  • Fax: 866-952-0945
Mailing address:
  • Phone: 904-414-1211
  • Fax: 866-952-0945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name: TAHNITA FLEMING
Title or Position: OWNER
Credential:
Phone: 904-414-1211