Organization
IDEAL SUPPORT SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYSSEEVETH SERRANO (OWNER/PROVIDER)
(772) 519-4053
Entity
Organization
Contact information
Practice address
1031 SW JERICHO AVE, PORT ST LUCIE, FL 34953-7216
(772) 519-4053
(772) 237-2590
Mailing address
1031 SW JERICHO AVE, PORT ST LUCIE, FL 34953-7216
(772) 519-4053
(772) 237-2590
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/07/2020
Last updated
01/07/2020
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