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General NPI Number Information
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NPI Number | 1295977338
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Entity Type | Organization
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Legal Business Name | MVP SUPPORT SERVICES, LLC
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Dates
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Enumeration Date | 04/06/2009
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Last Update Date | 04/06/2009
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Provider Practice Location Address
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Address Line | 701 SAN JOSE RD
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-6551
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Country | US
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Telephone | 904-797-4322
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Fax | 904-797-5472
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Provider Business Mailing Address
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Address Line | 701 SAN JOSE RD
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-6551
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Country | US
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Telephone | 904-797-4322
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Fax | 904-797-5472
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Authorized Official
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Title or Position | OWNER
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Name | CATHERINE MICHELLE CASON
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Credential |
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Telephone | 904-797-4322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 678512398
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 678512396
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License Number State | FL
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