Healthcare Provider Details

I. General information

NPI: 1275911588
Provider Name (Legal Business Name): AK SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 06/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 NW 17TH PL SUITE 312
SUNRISE FL
33313-6952
US

IV. Provider business mailing address

5975 W. SUNRISE BLVD SUITE 115
SUNRISE FL
33313
US

V. Phone/Fax

Practice location:
  • Phone: 954-663-9950
  • Fax:
Mailing address:
  • Phone: 954-663-9950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberM253-005-76-679-0
License Number StateFL

VIII. Authorized Official

Name: ANALEITHA MCINTOSH
Title or Position: ADMINISTRATOR
Credential:
Phone: 954-663-9950