Provider Demographics
NPI:1588024111
Name:EXCEPTIONAL SUPPORT SERVICE LLC
Entity Type:Organization
Organization Name:EXCEPTIONAL SUPPORT SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASMYNE
Authorized Official - Middle Name:V
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-222-8806
Mailing Address - Street 1:244 SW 121ST WAY
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-1184
Mailing Address - Country:US
Mailing Address - Phone:352-222-8806
Mailing Address - Fax:
Practice Address - Street 1:244 SW 121ST WAY
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-1184
Practice Address - Country:US
Practice Address - Phone:352-222-8806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC636438846380Medicaid