Provider Demographics
NPI:1588821144
Name:SERVICE INDUSTRY SOLUTIONS INC.
Entity Type:Organization
Organization Name:SERVICE INDUSTRY SOLUTIONS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRES
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-746-5102
Mailing Address - Street 1:2116 51ST BLVD E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-7153
Mailing Address - Country:US
Mailing Address - Phone:941-746-5102
Mailing Address - Fax:941-744-0471
Practice Address - Street 1:2116 51ST BLVD E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-7153
Practice Address - Country:US
Practice Address - Phone:941-746-5102
Practice Address - Fax:941-744-0471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL683110996Medicaid