Provider Demographics
NPI:1750131223
Name:GREATEST MINDS SUPPORT SERVICES
Entity type:Organization
Organization Name:GREATEST MINDS SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLENTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-217-4123
Mailing Address - Street 1:813 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-4124
Mailing Address - Country:US
Mailing Address - Phone:352-217-4123
Mailing Address - Fax:
Practice Address - Street 1:813 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-4124
Practice Address - Country:US
Practice Address - Phone:352-217-4123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty