Provider Demographics
NPI:1245118835
Name:REHOBOTH SUPPORT SERVICES LLC
Entity type:Organization
Organization Name:REHOBOTH SUPPORT SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ADANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANOKAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-575-7047
Mailing Address - Street 1:67 ADIRONDACK DR
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-3236
Mailing Address - Country:US
Mailing Address - Phone:631-575-7047
Mailing Address - Fax:
Practice Address - Street 1:67 ADIRONDACK DR
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-3236
Practice Address - Country:US
Practice Address - Phone:631-575-7047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-22
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services