Healthcare Provider Details

I. General information

NPI: 1194416446
Provider Name (Legal Business Name): INDEPENDENT SUPPORT CARE SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2188 S HAVERHILL RD
WEST PALM BEACH FL
33415-7352
US

IV. Provider business mailing address

PO BOX 16604
WEST PALM BEACH FL
33416-6604
US

V. Phone/Fax

Practice location:
  • Phone: 561-856-2081
  • Fax:
Mailing address:
  • Phone: 561-856-2081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: NATWONA FULLER
Title or Position: OWNER
Credential:
Phone: 561-856-2081