NPIMap

Organization Active NPI

Parent Support, LLC

Doing business as Heart Transformation Treatment

  • Mental Illness Community Based Residential Treatment Facility
  • Davenport, FL
National Provider Identifier
1528415247
Registry record updated May 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
CARF ACCREDITED Issued in FL
Legal business name
PARENT SUPPORT, LLC
Doing business as
Heart Transformation Treatment
Practice address
389 Sand Ridge Dr
Davenport, FL 33896-4717
Phone
(407) 901-4000
Fax
(407) 930-4830
NPI assigned
May 23, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2016

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

Authorized official

Name
Dr. Vickki-Ann S. Samuel, M.D.
Title
Medical Director
Phone
(407) 901-4000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X CARF ACCREDITED FL Primary

Addresses

Primary practice location

389 Sand Ridge Dr
Davenport, FL 33896-4717

Mailing address

389 Sand Ridge Dr
Davenport, FL 33896-4717
Phone (407) 901-4000

Other names 1

  • Heart Transformation Treatment Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Cares Treatment6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1463961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463961600000",
    "number": "1528415247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "389 SAND RIDGE DR",
            "city": "DAVENPORT",
            "state": "FL",
            "postal_code": "338964717",
            "telephone_number": "407-901-4000",
            "fax_number": "407-930-4830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "389 SAND RIDGE DR",
            "city": "DAVENPORT",
            "state": "FL",
            "postal_code": "338964717",
            "telephone_number": "407-901-4000",
            "fax_number": "407-930-4830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARENT SUPPORT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-23",
        "last_updated": "2016-05-23",
        "status": "A",
        "authorized_official_last_name": "SAMUEL",
        "authorized_official_first_name": "VICKKI-ANN",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "407-901-4000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "FL",
            "license": "CARF ACCREDITED",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heart Transformation Treatment",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Davenport, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2016; 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.