Healthcare Provider Details

I. General information

NPI: 1205132578
Provider Name (Legal Business Name): MULTI-DIMENSIONAL SERVICES & SUPPORTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2011
Last Update Date: 02/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 LORIMIER TER
JACKSONVILLE FL
32207-4146
US

IV. Provider business mailing address

2835 LORIMIER TER
JACKSONVILLE FL
32207-4146
US

V. Phone/Fax

Practice location:
  • Phone: 904-398-8235
  • Fax: 904-398-8235
Mailing address:
  • Phone: 904-398-8235
  • Fax: 904-398-8235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. MARTHA FORNOF
Title or Position: VICE PRESIDENT
Credential:
Phone: 904-398-8235