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General NPI Number Information
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NPI Number | 1497361950
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Entity Type | Organization
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Legal Business Name | INTEL PROFESSIONAL SERVICES, LLC
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Dates
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Enumeration Date | 09/21/2020
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Last Update Date | 09/21/2020
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Provider Practice Location Address
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Address Line | 3104 JUSTINE CT
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City | PANAMA CITY
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State | FL
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Zip | 32404-4106
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Country | US
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Telephone | 850-771-5197
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Fax |
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Provider Business Mailing Address
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Address Line | 2310 S HIGHWAY 77 STE 119
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City | LYNN HAVEN
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State | FL
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Zip | 32444-4616
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Country | US
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Telephone | 850-786-3524
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Fax | 386-230-3681
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Authorized Official
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Title or Position | CEO
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Name | MS. DOROTHY MICHELLE CLAY
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Credential |
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Telephone | 850-771-5197
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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 |
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License Number State |
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