Healthcare Provider Details

I. General information

NPI: 1033571716
Provider Name (Legal Business Name): HALL SUPPORTIVE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4675 SW 155TH PLACE RD
OCALA FL
34473-3187
US

IV. Provider business mailing address

4675 SW 155TH PLACE RD
OCALA FL
34473-3187
US

V. Phone/Fax

Practice location:
  • Phone: 813-887-5152
  • Fax: 352-307-4640
Mailing address:
  • Phone: 813-887-5152
  • Fax: 352-307-4640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: YVONNE THOMAS HALL
Title or Position: PRESIDENT
Credential:
Phone: 813-887-5152