Provider Demographics
NPI:1972256790
Name:NORTHEAST SUPPORT COORDINATION SERVICES INC
Entity Type:Organization
Organization Name:NORTHEAST SUPPORT COORDINATION SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAIGGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-387-2741
Mailing Address - Street 1:1545 CHARON RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-9201
Mailing Address - Country:US
Mailing Address - Phone:904-387-2741
Mailing Address - Fax:904-387-4774
Practice Address - Street 1:1545 CHARON RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-9201
Practice Address - Country:US
Practice Address - Phone:904-387-2741
Practice Address - Fax:904-387-4774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities