Provider Demographics
NPI:1568707818
Name:DAB SUPPORT SERVICES LLC
Entity Type:Organization
Organization Name:DAB SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-875-2278
Mailing Address - Street 1:945 CLASSIC VIEW DR
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823-2806
Mailing Address - Country:US
Mailing Address - Phone:863-875-2278
Mailing Address - Fax:863-875-2151
Practice Address - Street 1:945 CLASSIC VIEW DR
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:FL
Practice Address - Zip Code:33823-2806
Practice Address - Country:US
Practice Address - Phone:863-875-2278
Practice Address - Fax:863-875-2151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL002179700251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002179700Medicaid
FL692636396Medicaid