Provider Demographics
NPI:1679062814
Name:INTERDISCIPLINARY HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:INTERDISCIPLINARY HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLY-ANN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:COMMOCK
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:786-234-2999
Mailing Address - Street 1:12751 SW 226 STREET
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33170
Mailing Address - Country:US
Mailing Address - Phone:786-234-2999
Mailing Address - Fax:
Practice Address - Street 1:12751 SW 226 STREET
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33170
Practice Address - Country:US
Practice Address - Phone:786-234-2999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251J00000X, 310400000X
FL3104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251J00000XAgenciesNursing Care
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances