Organization
SUSAN SUPPORT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN RACHEL GOINS (WAIVER SUPPORT COORDINATOR)
(239) 362-5802
Entity
Organization
Contact information
Practice address
961 COCONUT DR, FORT MYERS, FL 33903-4201
(239) 362-5802
Mailing address
961 COCONUT DR, FORT MYERS, FL 33903-4201
(239) 362-5802
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Enumeration date
10/28/2021
Last updated
10/28/2021
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