Professional Disability Provider Services, Inc.

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

Legal business name

PROFESSIONAL DISABILITY PROVIDER SERVICES, INC.

Practice address

6501 Arlington Expy
Suite #156-B
Jacksonville, FL 32211-5779

Phone

(904) 727-0002

Fax

(904) 727-5070

NPI assigned

Apr 2, 2007

Last updated

Aug 22, 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

Mrs. Evelyn L.. Shipman

Title

Director

Phone

(904) 727-0002

Specialties & licenses 1

Addresses

Other names 1

• PDPS, Inc. Other name

Locations

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902927668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6501 ARLINGTON EXPY",
            "address_2": "SUITE #156-B",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322115779",
            "telephone_number": "904-727-0002",
            "fax_number": "904-727-5070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6501 ARLINGTON EXPY",
            "address_2": "SUITE #156-B",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322115779",
            "telephone_number": "904-727-0002",
            "fax_number": "904-727-5070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DISABILITY PROVIDER SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHIPMAN",
        "authorized_official_first_name": "EVELYN",
        "authorized_official_middle_name": "L..",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "904-727-0002",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PDPS, Inc.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.