Ideal Support Services, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

IDEAL SUPPORT SERVICES, LLC

Practice address

1031 SW Jericho Ave
Port St Lucie, FL 34953-7216

Phone

(772) 519-4053

Fax

(772) 237-2590

NPI assigned

Jan 7, 2020

Last updated

Jan 7, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lysseeveth SerranoNPI 1558901579

Title

Owner/Provider

Phone

(772) 519-4053

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lysseeveth Serrano

  • Adult Companion
  • Port St Lucie, FL
  • NPI 1558901579
  NPD Authorized official

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

{
    "created_epoch": "1578355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578355200000",
    "number": "1518507532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1031 SW JERICHO AVE",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349537216",
            "telephone_number": "772-519-4053",
            "fax_number": "772-237-2590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1031 SW JERICHO AVE",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349537216",
            "telephone_number": "772-519-4053",
            "fax_number": "772-237-2590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDEAL SUPPORT SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-07",
        "last_updated": "2020-01-07",
        "certification_date": "2020-01-07",
        "status": "A",
        "authorized_official_last_name": "SERRANO",
        "authorized_official_first_name": "LYSSEEVETH",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "772-519-4053"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Port St Lucie, FL
• Providers in Port St Lucie, FL by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2020; 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.