Provider Demographics
NPI:1053617514
Name:P.B. SUPPORT SERVICES INC.
Entity type:Organization
Organization Name:P.B. SUPPORT SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-779-8918
Mailing Address - Street 1:5562 TIMUQUANA RD STE 2
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-8053
Mailing Address - Country:US
Mailing Address - Phone:904-779-8918
Mailing Address - Fax:904-317-9926
Practice Address - Street 1:5562 TIMUQUANA RD STE 2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-8053
Practice Address - Country:US
Practice Address - Phone:904-779-8918
Practice Address - Fax:904-371-9926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL681937196251B00000X
FL681937102251B00000X
FL673923798251B00000X
FL673923768251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL681937102Medicaid
FL673923768Medicaid
FL681937196Medicaid
FL673923798Medicaid