Healthcare Provider Details

I. General information

NPI: 1669132171
Provider Name (Legal Business Name): SUPPLEMENTAL SUPPORT CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2021
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N DE VILLIERS ST STE 226
PENSACOLA FL
32501-3894
US

IV. Provider business mailing address

321 N DE VILLIERS ST STE 226
PENSACOLA FL
32501-3894
US

V. Phone/Fax

Practice location:
  • Phone: 850-741-2677
  • Fax: 850-285-0209
Mailing address:
  • Phone: 850-741-2677
  • Fax: 850-285-0209

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: MRS. GABRIELLE D SIMS
Title or Position: OWNER
Credential:
Phone: 850-293-6488