Provider Demographics
NPI:1497361950
Name:INTEL PROFESSIONAL SERVICES, LLC
Entity Type:Organization
Organization Name:INTEL PROFESSIONAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-771-5197
Mailing Address - Street 1:2310 S HIGHWAY 77 STE 119
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-4616
Mailing Address - Country:US
Mailing Address - Phone:850-786-3524
Mailing Address - Fax:386-230-3681
Practice Address - Street 1:3104 JUSTINE CT
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32404-4106
Practice Address - Country:US
Practice Address - Phone:850-771-5197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care