Provider Demographics
NPI:1841591807
Name:RENDON SUPPORT SERVICES, INC.
Entity Type:Organization
Organization Name:RENDON SUPPORT SERVICES, INC.
Other - Org Name:E TED BEAN & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RENDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-580-7147
Mailing Address - Street 1:4706 PRESTON WOODS DR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-7873
Mailing Address - Country:US
Mailing Address - Phone:813-684-2646
Mailing Address - Fax:813-643-1054
Practice Address - Street 1:1106 N PARSONS AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-3140
Practice Address - Country:US
Practice Address - Phone:813-684-2646
Practice Address - Fax:813-643-1054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL689611196Medicaid