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General NPI Number Information
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NPI Number | 1851885461
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Entity Type | Organization
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Legal Business Name | NELKIM SUPPORT SERVICES
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Dates
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Enumeration Date | 06/18/2018
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Last Update Date | 06/18/2018
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Provider Practice Location Address
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Address Line | 271 SW AUBUDON AVE
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34984-5029
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Country | US
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Telephone | 772-307-1334
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Fax |
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Provider Business Mailing Address
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Address Line | 271 SW AUBUDON AVE
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34984-5029
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Country | US
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Telephone | 772-307-1334
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KIMBERLY DIXON
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Credential |
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Telephone | 772-307-1334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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