Healthcare Provider Details

I. General information

NPI: 1922425255
Provider Name (Legal Business Name): CONSUMER SUPPORT NETWORK, LTD. CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2833 SW BRIGHTON ST
PORT ST LUCIE FL
34953-3265
US

IV. Provider business mailing address

2833 SW BRIGHTON ST
PORT ST LUCIE FL
34953-3265
US

V. Phone/Fax

Practice location:
  • Phone: 772-871-7863
  • Fax: 561-200-6271
Mailing address:
  • Phone: 772-871-7863
  • Fax: 561-200-6271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARCELLE JEAN-FRANCOIS
Title or Position: COO
Credential: M. ED.
Phone: 772-871-7863