Countyline Support Services Corp

Primary specialty

Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X

Legal business name

COUNTYLINE SUPPORT SERVICES CORP

Practice address

2114 N Flamingo Rd # 166
Pembroke Pines, FL 33028-3501

Phone

(954) 632-9891

NPI assigned

Aug 8, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mauva Angela Munford

Title

Owner

Phone

(954) 632-9891

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1533686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533686400000",
    "number": "1265911531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2114 N FLAMINGO RD # 166",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330283501",
            "telephone_number": "954-632-9891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2114 N FLAMINGO RD # 166",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330283501",
            "telephone_number": "954-632-9891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTYLINE SUPPORT SERVICES CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-08",
        "last_updated": "2018-08-08",
        "status": "A",
        "authorized_official_last_name": "MUNFORD",
        "authorized_official_first_name": "MAUVA",
        "authorized_official_middle_name": "ANGELA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "954-632-9891"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100207900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Denice Costello, RCSWI
• Michelle Cotayo-Linares, MSN, APRN, FNP-BC
• Elena Cotayo, OTR/L
• Kathy Cotty
• County Dental Corp.
• Barbie Courtney, ARNP
• Coverson a&G Holdings, LLC
• Cierra Denese Covington
• Marc Cowan, DDS
• Cozy Care Residence of Pembroke Pines

• Developmental Disabilities Clinic/Center in Pembroke Pines, FL
• Providers in Pembroke Pines, FL by specialty
• Developmental Disabilities Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.