Provider Demographics
NPI:1972054252
Name:ASG SUPPORT SERVICES INC
Entity Type:Organization
Organization Name:ASG SUPPORT SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SANG
Authorized Official - Middle Name:YOOL
Authorized Official - Last Name:SUH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-453-6002
Mailing Address - Street 1:16501 NIKKI LN
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-6007
Mailing Address - Country:US
Mailing Address - Phone:813-416-2190
Mailing Address - Fax:813-475-4420
Practice Address - Street 1:16501 NIKKI LN
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-6007
Practice Address - Country:US
Practice Address - Phone:813-416-2190
Practice Address - Fax:813-475-4420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010254400Medicaid