Provider Demographics
NPI:1295187243
Name:IDEAL SUPPORT SERVICES
Entity Type:Organization
Organization Name:IDEAL SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-442-6043
Mailing Address - Street 1:6031 KANSAS AVE NW
Mailing Address - Street 2:NW SUITE 201
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-1566
Mailing Address - Country:US
Mailing Address - Phone:410-258-9310
Mailing Address - Fax:410-665-7558
Practice Address - Street 1:6031 KANSAS AVE NW
Practice Address - Street 2:NW SUITE 201
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-1566
Practice Address - Country:US
Practice Address - Phone:410-258-9310
Practice Address - Fax:410-665-7558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management