MEDICARE: A BIT ABOVE SUPPORT SERVICES

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	261QD1600X	Developmental Disabilities Clinic/Center

General Provider Information

NPI Number	:	1306303235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A BIT ABOVE SUPPORT SERVICES

Provider Business Mailing Address
First Line	:	6120 GOLDEN GROVE RD W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-2633
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6120 GOLDEN GROVE RD W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-2633
Country	:	US
Telephone Number	:	904-707-7280
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LANISHA JEREMEKA CARODINE
Credential	:
Telephone Number	:	904-707-7280

Provider Enumeration Date	:	02/27/2019
Last Update Date	:	02/27/2019

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Directions to “A BIT ABOVE SUPPORT SERVICES ” Practice Location

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