Provider Demographics
NPI:1891235792
Name:ASSOCIATED SERVICES AND SUPPLIES, INC.
Entity Type:Organization
Organization Name:ASSOCIATED SERVICES AND SUPPLIES, INC.
Other - Org Name:ASSOCIATED SERVICES CLEANING AND RESTORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:FAIRCLOTH
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-681-3148
Mailing Address - Street 1:PO BOX 5805
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32314-5805
Mailing Address - Country:US
Mailing Address - Phone:850-681-3148
Mailing Address - Fax:
Practice Address - Street 1:3452 GARBER DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-1114
Practice Address - Country:US
Practice Address - Phone:850-681-3148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL37-64-00836253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care