MEDICARE: SUPPORT SERVICES.COM, 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	253Z00000X	In Home Supportive Care 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

General Provider Information

NPI Number	:	1811515125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPPORT SERVICES.COM, LLC

Provider Business Mailing Address
First Line	:	PO BOX 8294
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32239-0294
Country	:	US
Telephone Number	:	904-382-5436
Fax Number	:	904-212-0417

Provider Business Practice Location Address
First Line	:	2121 CORPORATE SQUARE BLVD STE 118
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-1977
Country	:	US
Telephone Number	:	904-382-5436
Fax Number	:	904-212-0417

Authorized Official
Title or Position	:	SUPPORT COORDINATOR
Name	:	MR. RONALD ANTHONY MCCAULEY
Credential	:
Telephone Number	:	904-382-5436

Provider Enumeration Date	:	07/13/2020
Last Update Date	:	07/13/2020

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