Provider Demographics
NPI:1902927668
Name:PROFESSIONAL DISABILITY PROVIDER SERVICES, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL DISABILITY PROVIDER SERVICES, INC.
Other - Org Name:PDPS, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHIPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-727-0002
Mailing Address - Street 1:6501 ARLINGTON EXPY
Mailing Address - Street 2:SUITE #156-B
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-5779
Mailing Address - Country:US
Mailing Address - Phone:904-727-0002
Mailing Address - Fax:904-727-5070
Practice Address - Street 1:6501 ARLINGTON EXPY
Practice Address - Street 2:SUITE #156-B
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-5779
Practice Address - Country:US
Practice Address - Phone:904-727-0002
Practice Address - Fax:904-727-5070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services