Organization
SUPPORTIVE SPACE HOME CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONIQUE MARIE CANNON N/A (ADMIN)
(317) 473-0037
Entity
Organization
Contact information
Practice address
352 TANGLEWOOD DR, DAVENPORT, FL 33896-3106
(317) 473-0037
Mailing address
352 TANGLEWOOD DR, DAVENPORT, FL 33896-3106
(317) 473-0037
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Enumeration date
10/28/2025
Last updated
11/18/2025
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