Provider Demographics
NPI:1184133795
Name:AHSAP SUPPORT SERVICES LLC
Entity type:Organization
Organization Name:AHSAP SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIEDRE
Authorized Official - Middle Name:YOLANDA
Authorized Official - Last Name:COLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-537-7875
Mailing Address - Street 1:2121 CORPORATE SQUARE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-0309
Mailing Address - Country:US
Mailing Address - Phone:904-537-7875
Mailing Address - Fax:904-339-9674
Practice Address - Street 1:2121 CORPORATE SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-0309
Practice Address - Country:US
Practice Address - Phone:904-537-7875
Practice Address - Fax:904-339-9674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care