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General NPI Number Information
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NPI Number | 1609194646
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Entity Type | Organization
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Legal Business Name | HARDCORE SUPPORT SERVICES, INC.
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Dates
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Enumeration Date | 05/14/2010
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Last Update Date | 05/14/2010
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Provider Practice Location Address
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Address Line | 4502 SW FLORAL ST
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City | PORT ST LUCIE
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State | FL
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Zip | 34953-7621
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Country | US
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Telephone | 772-293-9734
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Fax | 863-223-2089
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Provider Business Mailing Address
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Address Line | 4502 SW FLORAL ST
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City | PORT ST LUCIE
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State | FL
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Zip | 34953-7621
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF BEHAVIORAL SERVICES
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Name | ROBERT ANDREAS ROLLE
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Credential | BCABA
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Telephone | 772-293-9734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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