Provider Demographics
NPI:1184925752
Name:JOHN BIRD COMMUNITY SUPPORTS
Entity type:Organization
Organization Name:JOHN BIRD COMMUNITY SUPPORTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:IERENE
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-685-9684
Mailing Address - Street 1:4788 253RD ST E
Mailing Address - Street 2:
Mailing Address - City:MYAKKA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34251-8956
Mailing Address - Country:US
Mailing Address - Phone:941-920-1533
Mailing Address - Fax:941-362-9798
Practice Address - Street 1:4788 253RD ST E
Practice Address - Street 2:
Practice Address - City:MYAKKA CITY
Practice Address - State:FL
Practice Address - Zip Code:34251-8956
Practice Address - Country:US
Practice Address - Phone:941-920-1533
Practice Address - Fax:941-362-9798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL000992301251B00000X
FL000992300251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000992300OtherMEDICAID WAIVER
FL000992301OtherMEDICAID SMALL WAIVER