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General NPI Number Information
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NPI Number | 1538923412
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Entity Type | Organization
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Legal Business Name | SINCERE OPEN SUPPORT SERVICES LLC
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Dates
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Enumeration Date | 02/12/2024
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 5164 E 81ST AVE STE 237
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City | MERRILLVILLE
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State | IN
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Zip | 46410-5852
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Country | US
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Telephone | 219-885-9049
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Fax |
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Provider Business Mailing Address
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Address Line | 5164 E 81ST AVE STE 237
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City | MERRILLVILLE
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State | IN
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Zip | 46410-5852
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Country | US
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Telephone | 219-885-9049
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | KIMBERLY ANGELICA CONGRESS-JONES
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Credential |
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Telephone | 219-885-9049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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