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General NPI Number Information
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NPI Number | 1871259622
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Entity Type | Organization
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Legal Business Name | FLORIDA SERVICE GROUP LLC
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Dates
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Enumeration Date | 11/16/2021
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Last Update Date | 11/16/2021
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Provider Practice Location Address
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Address Line | 5648 TOMOKA DR
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City | ORLANDO
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State | FL
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Zip | 32839-2849
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Country | US
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Telephone | 404-694-4298
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Fax | 407-992-9464
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Provider Business Mailing Address
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Address Line | 5648 TOMOKA DR
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City | ORLANDO
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State | FL
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Zip | 32839-2849
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Country | US
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Telephone | 404-694-4298
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | AMARA SMITH
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Credential | M.A.
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Telephone | 404-694-4298
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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