Provider Demographics
NPI:1528415247
Name:PARENT SUPPORT, LLC
Entity Type:Organization
Organization Name:PARENT SUPPORT, LLC
Other - Org Name:HEART TRANSFORMATION TREATMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VICKKI-ANN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-901-4000
Mailing Address - Street 1:389 SAND RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33896-4717
Mailing Address - Country:US
Mailing Address - Phone:407-901-4000
Mailing Address - Fax:407-930-4830
Practice Address - Street 1:389 SAND RIDGE DR
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33896-4717
Practice Address - Country:US
Practice Address - Phone:407-901-4000
Practice Address - Fax:407-930-4830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCARF ACCREDITED320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness