Provider Demographics
NPI:1518538529
Name:PUZZLE PIECES SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:PUZZLE PIECES SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KECHIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-605-5555
Mailing Address - Street 1:11700 N 58TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1692
Mailing Address - Country:US
Mailing Address - Phone:813-605-5555
Mailing Address - Fax:
Practice Address - Street 1:4820 FLORAMAR TER
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-3302
Practice Address - Country:US
Practice Address - Phone:727-378-2424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PUZZLE PIECES SUPPORT SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-09
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management