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General NPI Number Information
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NPI Number | 1891235792
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Entity Type | Organization
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Legal Business Name | ASSOCIATED SERVICES AND SUPPLIES, INC.
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Dates
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Enumeration Date | 02/27/2017
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Last Update Date | 02/27/2017
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Provider Practice Location Address
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Address Line | 3452 GARBER DR
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City | TALLAHASSEE
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State | FL
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Zip | 32303-1114
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Country | US
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Telephone | 850-681-3148
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5805
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City | TALLAHASSEE
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State | FL
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Zip | 32314-5805
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Country | US
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Telephone | 850-681-3148
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. MARY FAIRCLOTH WALSH
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Credential |
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Telephone | 850-681-3148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 37-64-00836
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License Number State | FL
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