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General NPI Number Information
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NPI Number | 1053617514
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Entity Type | Organization
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Legal Business Name | P.B. SUPPORT SERVICES INC.
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Dates
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Enumeration Date | 02/01/2011
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Last Update Date | 02/01/2011
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Provider Practice Location Address
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Address Line | 5562 TIMUQUANA RD STE 2
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City | JACKSONVILLE
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State | FL
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Zip | 32210-8053
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Country | US
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Telephone | 904-779-8918
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Fax | 904-371-9926
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Provider Business Mailing Address
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Address Line | 5562 TIMUQUANA RD STE 2
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City | JACKSONVILLE
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State | FL
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Zip | 32210-8053
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Country | US
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Telephone | 904-779-8918
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Fax | 904-317-9926
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Authorized Official
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Title or Position | DIRECT / OWNER
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Name | MR. LEONARD D BREWER
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Credential |
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Telephone | 940-779-8918
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 681937102
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 673923798
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 673923768
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 681937196
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License Number State | FL
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