MEDICARE: CONSTELLATION SUPPORT SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205549078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONSTELLATION SUPPORT SERVICES LLC

Provider Business Mailing Address
First Line	:	7726 WINEGARD RD STE 53
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32809-7147
Country	:	US
Telephone Number	:	407-900-5278
Fax Number	:

Provider Business Practice Location Address
First Line	:	5726 OLD CHENEY HWY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-3525
Country	:	US
Telephone Number	:	407-900-5278
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CORALIS CALDERON
Credential	:
Telephone Number	:	407-902-5919

Provider Enumeration Date	:	12/26/2022
Last Update Date	:	11/18/2024

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Directions to “CONSTELLATION SUPPORT SERVICES LLC ” Practice Location

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