Provider Demographics
NPI:1508519141
Name:DEMONT SUPPORT COORDINATORS LLC
Entity Type:Organization
Organization Name:DEMONT SUPPORT COORDINATORS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMONT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-632-7039
Mailing Address - Street 1:1011 REPUBLIC CT
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-9149
Mailing Address - Country:US
Mailing Address - Phone:561-632-7039
Mailing Address - Fax:
Practice Address - Street 1:1011 REPUBLIC CT
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-9149
Practice Address - Country:US
Practice Address - Phone:561-632-7039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty