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General NPI Number Information
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NPI Number | 1558653204
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Entity Type | Organization
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Legal Business Name | SUPPORTING INDEPENDENCE INC
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Dates
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Enumeration Date | 05/12/2011
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Last Update Date | 09/21/2015
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Provider Practice Location Address
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Address Line | 2200 LUCIEN WAY SUITE 175
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City | MAITLAND
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State | FL
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Zip | 32751-7007
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Country | US
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Telephone | 407-434-0766
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Fax | 407-434-0766
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Provider Business Mailing Address
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Address Line | 2200 LUCIEN WAY SUITE 175
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City | MAITLAND
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State | FL
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Zip | 32751
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Country | US
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Telephone | 407-434-0766
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Fax | 407-434-0766
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Authorized Official
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Title or Position | OWNER
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Name | MR. CHRIS PARK
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Credential |
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Telephone | 407-434-0766
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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 | 299993995
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 299993995
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License Number State | FL
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