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General NPI Number Information
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NPI Number | 1407727951
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Entity Type | Organization
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Legal Business Name | SUPPORTING & IMPROVING LIVES, LLC
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Dates
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Enumeration Date | 09/17/2025
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 3119 SPRING GLEN RD STE 102
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City | JACKSONVILLE
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State | FL
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Zip | 32207-5921
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Country | US
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Telephone | 904-514-1242
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Fax | 904-758-5409
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Provider Business Mailing Address
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Address Line | 3954 ANDERSON WOODS DR
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City | JACKSONVILLE
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State | FL
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Zip | 32218-9218
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Country | US
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Telephone | 904-514-1242
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Fax | 904-758-5409
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Authorized Official
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Title or Position | QO OWNER/ WSC
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Name | MS. DEANA ROBERTS
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Credential | MPH
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Telephone | 904-514-1242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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