Organization
INDIVIDUALIZED SUPPORT SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENA ARLENE BAKER (ONER)
(772) 696-3189
Entity
Organization
Contact information
Practice address
1965 42ND AVE STE 3, VERO BEACH, FL 32960-2502
(772) 492-9159
(772) 492-9147
Mailing address
234 SW STARFLOWER AVE, PORT ST LUCIE, FL 34984-4461
(772) 696-3189
(772) 492-9147
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
001173600
FL
251E00000X
Home Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001173600
PROVIDER NUMBER (HCBS) AND (FSL)
FL
Enumeration date
10/19/2009
Last updated
10/19/2009
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