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General NPI Number Information
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NPI Number | 1679352538
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Entity Type | Organization
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Legal Business Name | FAVORED SUPPORT SERVICES LLC
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Dates
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Enumeration Date | 09/28/2023
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Last Update Date | 09/28/2023
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Provider Practice Location Address
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Address Line | 8970 103RD ST STE 9
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City | JACKSONVILLE
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State | FL
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Zip | 32210-8689
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Country | US
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Telephone | 904-374-6280
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Fax |
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Provider Business Mailing Address
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Address Line | 8970 103RD ST STE 9
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City | JACKSONVILLE
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State | FL
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Zip | 32210-8689
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Country | US
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Telephone | 904-374-6280
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TIEARRA KNEIVA DICKENS
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Credential |
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Telephone | 904-463-3917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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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 | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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