Provider Demographics
NPI:1407113723
Name:SORINITY SUPPORT SERVICES LLC
Entity Type:Organization
Organization Name:SORINITY SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALVINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-273-6377
Mailing Address - Street 1:4000 FABER PLACE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-8587
Mailing Address - Country:US
Mailing Address - Phone:866-273-6377
Mailing Address - Fax:866-364-7607
Practice Address - Street 1:4000 FABER PLACE DR STE 300
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-8587
Practice Address - Country:US
Practice Address - Phone:866-273-6377
Practice Address - Fax:866-364-7607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000587600Medicaid