Provider Demographics
NPI:1568479210
Name:ABILITIES SUPPORT PROVIDER, INC.
Entity Type:Organization
Organization Name:ABILITIES SUPPORT PROVIDER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:TYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-344-4341
Mailing Address - Street 1:PO BOX 771042
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-0018
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:786-226-8855
Practice Address - Street 1:2305 NE 37TH RD
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-5137
Practice Address - Country:US
Practice Address - Phone:786-344-4341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services