Basic Information
Provider Information | |||||||||
NPI: | 1578656179 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ABILITY HEALTH SERVICES, INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | ABILITY REHABILITATION | ||||||||
OtherOrganizationType: | 5 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 401 VENTURE DR | ||||||||
Address2: | C | ||||||||
City: | SOUTH DAYTONA | ||||||||
State: | FL | ||||||||
PostalCode: | 321193478 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3867605042 | ||||||||
FaxNumber: | 3867605046 | ||||||||
Practice Location | |||||||||
Address1: | 7400 RED BUG LAKE RD | ||||||||
Address2: |   | ||||||||
City: | OVIEDO | ||||||||
State: | FL | ||||||||
PostalCode: | 32765 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4079712774 | ||||||||
FaxNumber: | 4079712776 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/02/2006 | ||||||||
LastUpdateDate: | 07/11/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | GUERRINA | ||||||||
AuthorizedOfficialFirstName: | JOHN | ||||||||
AuthorizedOfficialMiddleName: | E | ||||||||
AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 4076880070 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | ATC/L,CSCS,LMT | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | PT 18150 | FL | Y |   | Suppliers | Durable Medical Equipment & Medical Supplies |   |
No ID Information.