Organization
IMPERIAL CONNECTIONS SUPPORT PROGRAMS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMERLYN JOHNSON ED.S. (OWNER)
(813) 395-9950
Entity
Organization
Contact information
Practice address
9806 N CONNECHUSETT RD, TAMPA, FL 33617
(813) 395-9950
(813) 364-6474
Mailing address
5450 BRUCE B DOWNS BLVD STE 328, WESLEY CHAPEL, FL 33544-8616
(813) 395-9950
(813) 364-6474
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
235233
FL
253Z00000X
In Home Supportive Care Agency
022101700
FL
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
022101700
FL
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
022101700
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022101700
—
FL
Enumeration date
04/23/2018
Last updated
05/30/2018
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