Provider Demographics
NPI:1205406790
Name:DYNAMIC SUPPORTS AND SERVICES, LLC
Entity Type:Organization
Organization Name:DYNAMIC SUPPORTS AND SERVICES, LLC
Other - Org Name:DYNAMIC SUPPORTS AND SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TELESHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:321-287-8570
Mailing Address - Street 1:3700 34TH ST STE 100G
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-6606
Mailing Address - Country:US
Mailing Address - Phone:407-730-4242
Mailing Address - Fax:
Practice Address - Street 1:3460 BASIE PL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-2910
Practice Address - Country:US
Practice Address - Phone:321-287-8570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child