Provider Demographics
NPI:1669819256
Name:DEVELOPMENTAL REHABILITATIVE SERVICES
Entity Type:Organization
Organization Name:DEVELOPMENTAL REHABILITATIVE SERVICES
Other - Org Name:INTERGRITY SUPPORTS & SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ABERCRUMBIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-838-5792
Mailing Address - Street 1:102 EL RANCHO DR
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32347-1716
Mailing Address - Country:US
Mailing Address - Phone:850-838-5792
Mailing Address - Fax:
Practice Address - Street 1:102 EL RANCHO DR
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32347-1716
Practice Address - Country:US
Practice Address - Phone:850-838-5792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL07000057652253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL677703196Medicaid