Provider Demographics
NPI:1063040483
Name:JD SANTOS SUPPORT SERVICES AGENCY LLC
Entity Type:Organization
Organization Name:JD SANTOS SUPPORT SERVICES AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DOS SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-419-6699
Mailing Address - Street 1:3399 PATTERSON HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-8215
Mailing Address - Country:US
Mailing Address - Phone:863-419-6699
Mailing Address - Fax:
Practice Address - Street 1:3399 PATTERSON HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-8215
Practice Address - Country:US
Practice Address - Phone:863-419-6699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health