Provider Demographics
NPI:1093469736
Name:ACHIEVABLE ABILITIES SUPPORT SERVICES
Entity Type:Organization
Organization Name:ACHIEVABLE ABILITIES SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-204-7911
Mailing Address - Street 1:6727 1ST AVE S STE 209
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-1341
Mailing Address - Country:US
Mailing Address - Phone:727-204-7911
Mailing Address - Fax:
Practice Address - Street 1:6727 1ST AVE S STE 209
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-1341
Practice Address - Country:US
Practice Address - Phone:727-204-7911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101553100Medicaid