Provider Demographics
NPI:1891394433
Name:SUPPLEMENTAL RELIEF LLC
Entity Type:Organization
Organization Name:SUPPLEMENTAL RELIEF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:ERNE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:954-325-0030
Mailing Address - Street 1:1 E BROWARD BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-1876
Mailing Address - Country:US
Mailing Address - Phone:954-369-1005
Mailing Address - Fax:
Practice Address - Street 1:1 E BROWARD BLVD STE 700
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-1876
Practice Address - Country:US
Practice Address - Phone:954-325-0030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-24
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385H00000XRespite Care FacilityRespite Care