Supporting Individuals With Disabilities Inc

Primary specialty

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

Legal business name

SUPPORTING INDIVIDUALS WITH DISABILITIES INC

Practice address

95129 Springhill Rd
Fernandina Beach, FL 32034-9410

Phone

(904) 507-9976

NPI assigned

May 10, 2024

Organization subpart

No

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

Authorized official

Name

Jessica D Freeman

Title

Administrator

Phone

(904) 507-9976

Specialties & licenses 2

Addresses

Other names 1

• SIWDINC Doing business as

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

{
    "created_epoch": "1715299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715299200000",
    "number": "1962250233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95129 SPRINGHILL RD",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320349410",
            "telephone_number": "904-507-9976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95129 SPRINGHILL RD",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320349410",
            "telephone_number": "904-507-9976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPPORTING INDIVIDUALS WITH DISABILITIES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-10",
        "last_updated": "2024-05-10",
        "certification_date": "2024-05-10",
        "status": "A",
        "authorized_official_last_name": "FREEMAN",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "904-507-9976"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "385HR2060X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SIWDINC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stephen D. Stubits, O.D.
• Amber L. Stuckey, APRN
• Melinda Baskin Sullivan, LMHC
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• Neelie Brigman Sutton, MSN
• Erica Swaringen, RCMHI
• Tae Y Rho MD PA
• Kimberly Kaye Taylor, LMHC

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Fernandina Beach, FL
• Providers in Fernandina Beach, 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 May 10, 2024; 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.