Organization
COUNTYLINE SUPPORT SERVICES CORP
Active
Organization
COUNTYLINE SUPPORT SERVICES CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAUVA ANGELA MUNFORD (OWNER)
(954) 632-9891
Entity
Organization
Contact information
Practice address
2114 N FLAMINGO RD # 166, PEMBROKE PINES, FL 33028-3501
(954) 632-9891
Mailing address
2114 N FLAMINGO RD # 166, PEMBROKE PINES, FL 33028-3501
(954) 632-9891
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100207900
—
FL
Enumeration date
08/08/2018
Last updated
08/08/2018
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