Provider Demographics
NPI:1942665187
Name:H2H SUPPORT SERVICES
Entity Type:Organization
Organization Name:H2H SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARRIETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:901-338-5421
Mailing Address - Street 1:31 W ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-3605
Mailing Address - Country:US
Mailing Address - Phone:901-338-5421
Mailing Address - Fax:904-379-0801
Practice Address - Street 1:330 W 70TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-3810
Practice Address - Country:US
Practice Address - Phone:901-338-5421
Practice Address - Fax:904-379-0801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1366645673252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1477966471Medicaid