Provider Demographics
NPI:1982983128
Name:SUPPORT DEVELOPMENT SERVICES, INC
Entity Type:Organization
Organization Name:SUPPORT DEVELOPMENT SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-965-3149
Mailing Address - Street 1:PO BOX 360482
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33673-0482
Mailing Address - Country:US
Mailing Address - Phone:813-965-3149
Mailing Address - Fax:813-405-4258
Practice Address - Street 1:1006 E CAYUGA ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-4131
Practice Address - Country:US
Practice Address - Phone:813-965-3149
Practice Address - Fax:813-405-4258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL172V00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========Medicaid
FL=========OtherMEDICARE