Provider Demographics
NPI:1215492582
Name:HALL & ASSOCIATES SUPPORTIVE SERVICES INC
Entity type:Organization
Organization Name:HALL & ASSOCIATES SUPPORTIVE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-887-5152
Mailing Address - Street 1:PO BOX 772192
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34477-2192
Mailing Address - Country:US
Mailing Address - Phone:813-887-5152
Mailing Address - Fax:352-307-4426
Practice Address - Street 1:14213 SW 48TH AVENUE RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34473-2381
Practice Address - Country:US
Practice Address - Phone:813-887-5152
Practice Address - Fax:352-307-4426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-31
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive Care
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101015600Medicaid