Provider Demographics
NPI:1679383707
Name:VILLAGE SUPPORT SYSTEM SERVICES THE VILLAGE
Entity type:Organization
Organization Name:VILLAGE SUPPORT SYSTEM SERVICES THE VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ORTIZ DAVILA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:407-300-1171
Mailing Address - Street 1:8746 CLAIBORNE CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-3498
Mailing Address - Country:US
Mailing Address - Phone:407-300-1171
Mailing Address - Fax:
Practice Address - Street 1:8746 CLAIBORNE CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-3498
Practice Address - Country:US
Practice Address - Phone:407-300-1171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VILLAGE SUPPORT SYSTEM SERVICES THE VILLAGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty