=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801165097
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SIMPKINS SUPERIOR SUPPORT SERVICES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2011
-----------------------------------------------------
Last Update Date | 12/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1017 SW 8TH ST UNIT B
-----------------------------------------------------
City | HALLANDALE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33009-6737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-222-4180
-----------------------------------------------------
Fax | 954-239-8894
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 567
-----------------------------------------------------
City | HALLANDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33008-0567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-222-4180
-----------------------------------------------------
Fax | 954-239-8894
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | MRS. LASONJA TERRELL SIMPKINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-222-4180
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 385HR2060X
-----------------------------------------------------
Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
-----------------------------------------------------
License Number | 003710800
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 003710800
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------