Provider Demographics
NPI:1942757661
Name:PARENT SUPPORT, LLC
Entity Type:Organization
Organization Name:PARENT SUPPORT, LLC
Other - Org Name:CARES TREATMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VICKKI-ANN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:947-282-4222
Mailing Address - Street 1:3218 EAGLE WATCH DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-3138
Mailing Address - Country:US
Mailing Address - Phone:407-901-4000
Mailing Address - Fax:407-930-4830
Practice Address - Street 1:1442 BRUSH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-2285
Practice Address - Country:US
Practice Address - Phone:947-282-4222
Practice Address - Fax:407-930-4830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-11
Last Update Date:2016-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)