Provider Demographics
NPI:1801165097
Name:SIMPKINS SUPERIOR SUPPORT SERVICES INC.
Entity type:Organization
Organization Name:SIMPKINS SUPERIOR SUPPORT SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LASONJA
Authorized Official - Middle Name:TERRELL
Authorized Official - Last Name:SIMPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-222-4180
Mailing Address - Street 1:PO BOX 567
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33008-0567
Mailing Address - Country:US
Mailing Address - Phone:786-222-4180
Mailing Address - Fax:954-239-8894
Practice Address - Street 1:1017 SW 8TH ST
Practice Address - Street 2:UNIT B
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-6737
Practice Address - Country:US
Practice Address - Phone:786-222-4180
Practice Address - Fax:954-239-8894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL003710800385HR2060X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003710800Medicaid