Provider Demographics
NPI:1902065386
Name:ZVG SUPPORT SERVICES
Entity Type:Organization
Organization Name:ZVG SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:MENESES
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:WSC
Authorized Official - Phone:305-968-1337
Mailing Address - Street 1:4001 SW 144TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7844
Mailing Address - Country:US
Mailing Address - Phone:305-968-1337
Mailing Address - Fax:305-226-7016
Practice Address - Street 1:4001 SW 144TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-7844
Practice Address - Country:US
Practice Address - Phone:305-968-1337
Practice Address - Fax:305-226-7016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL684706496OtherHOME COMMUNITY BASES SERVICES DD
FL684706498OtherHOME COMMUNITY BASED SEVICES FSL