Provider Demographics
NPI:1558653204
Name:SUPPORTING INDEPENDENCE INC
Entity type:Organization
Organization Name:SUPPORTING INDEPENDENCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-434-0766
Mailing Address - Street 1:2200 LUCIEN WAY
Mailing Address - Street 2:SUITE 175
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751
Mailing Address - Country:US
Mailing Address - Phone:407-434-0766
Mailing Address - Fax:407-434-0766
Practice Address - Street 1:2200 LUCIEN WAY
Practice Address - Street 2:SUITE 175
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7007
Practice Address - Country:US
Practice Address - Phone:407-434-0766
Practice Address - Fax:407-434-0766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299993995251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherFEDERAL TAX ID