MEDICARE: PS PROVIDING SUPPORTS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	253J00000X	Foster Care Agency
2	253Z00000X	In Home Supportive Care Agency
3	261QH0100X	Health Service Clinic/Center

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

General Provider Information

NPI Number	:	1437888450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PS PROVIDING SUPPORTS

Provider Business Mailing Address
First Line	:	381 MELODY CT
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33916-1055
Country	:	US
Telephone Number	:	239-689-3695
Fax Number	:

Provider Business Practice Location Address
First Line	:	381 MELODY CT
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33916-1055
Country	:	US
Telephone Number	:	239-689-3695
Fax Number	:

Authorized Official
Title or Position	:	ONWER/OPERATOR
Name	:	ARLANA BARNES
Credential	:
Telephone Number	:	239-689-3695

Provider Enumeration Date	:	06/06/2022
Last Update Date	:	06/06/2022

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Directions to “PS PROVIDING SUPPORTS ” Practice Location

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