Provider Demographics
NPI:1033546270
Name:COMMON SPRINGS SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:COMMON SPRINGS SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERMINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-583-3634
Mailing Address - Street 1:PO BOX 994
Mailing Address - Street 2:
Mailing Address - City:LACOOCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33537-0994
Mailing Address - Country:US
Mailing Address - Phone:352-583-3634
Mailing Address - Fax:
Practice Address - Street 1:6188 SHARON CT
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:FL
Practice Address - Zip Code:33597-9700
Practice Address - Country:US
Practice Address - Phone:352-583-3634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL232848253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005443200Medicaid
FL006787600Medicaid