Provider Demographics
NPI:1609194646
Name:HARDCORE SUPPORT SERVICES, INC.
Entity Type:Organization
Organization Name:HARDCORE SUPPORT SERVICES, INC.
Other - Org Name:HARDCORE SUPPORT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BEHAVIORAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANDREAS
Authorized Official - Last Name:ROLLE
Authorized Official - Suffix:
Authorized Official - Credentials:BCABA
Authorized Official - Phone:772-293-9734
Mailing Address - Street 1:4502 SW FLORAL ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-7621
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4502 SW FLORAL ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-7621
Practice Address - Country:US
Practice Address - Phone:772-293-9734
Practice Address - Fax:863-223-2089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health