Support Independent Living

LBN: Support Independent Living
Support Independent Living is an health care organization with primary practice located at 11 Racetrack Rd Ne Ste C2 , Fort Walton Beach FL 32547-1867. The organization recently has only one registered license in Ambulatory Health Care Facilities / Developmental Disabilities, which is considered as the primary health care specialty. Support Independent Living can be contacted via phone (850) 259-7190, or through Marrier, Brenda F via phone (850) 259-7190.

Contact Information

Primary practice address
11 Racetrack Rd Ne Ste C2 Fort Walton Beach FL 32547-1867
Phone: (850) 259-7190
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Marrier, Brenda F
Phone: (850) 259-7190

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Developmental Disabilities 261QD1600X

Profile Details

NPI number 1306590260
LBN Legal business name Support Independent Living
DBA Doing business as
Authorized official Marrier, Brenda F
Entity Organization
Organization subpart 1 No
Enumeration date Feb 9th, 2022
Last updated Feb 9th, 2022 - about 2 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306590260 NPPES
Florida MEDICAID 684509696

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