Healthcare Provider Details

I. General information

NPI: 1295977338
Provider Name (Legal Business Name): MVP SUPPORT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 SAN JOSE RD
ST AUGUSTINE FL
32086-6551
US

IV. Provider business mailing address

701 SAN JOSE RD
ST AUGUSTINE FL
32086-6551
US

V. Phone/Fax

Practice location:
  • Phone: 904-797-4322
  • Fax: 904-797-5472
Mailing address:
  • Phone: 904-797-4322
  • Fax: 904-797-5472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number678512398
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number678512396
License Number StateFL

VIII. Authorized Official

Name: CATHERINE MICHELLE CASON
Title or Position: OWNER
Credential:
Phone: 904-797-4322