Provider Demographics
NPI:1235531690
Name:POWELL SUPPORTIVE SERVICES INC
Entity Type:Organization
Organization Name:POWELL SUPPORTIVE SERVICES INC
Other - Org Name:BRADENTON PALMS ALF I
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-767-3808
Mailing Address - Street 1:802 71ST ST NW
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-1515
Mailing Address - Country:US
Mailing Address - Phone:813-767-3808
Mailing Address - Fax:
Practice Address - Street 1:802 71ST ST NW
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-1515
Practice Address - Country:US
Practice Address - Phone:813-767-3808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12389310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility