Provider Demographics
NPI:1740878677
Name:FAMILY SUPPORTIVE SERVICES, INC
Entity type:Organization
Organization Name:FAMILY SUPPORTIVE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:321-443-7191
Mailing Address - Street 1:3510 RODRICK CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-4294
Mailing Address - Country:US
Mailing Address - Phone:321-443-7191
Mailing Address - Fax:
Practice Address - Street 1:439 GASTON FOSTER RD STE E
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-1231
Practice Address - Country:US
Practice Address - Phone:406-617-6438
Practice Address - Fax:407-612-2320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty