Provider Demographics
NPI:1144850835
Name:SAFEKEEPING SUPPORT SERVICES, LLC
Entity type:Organization
Organization Name:SAFEKEEPING SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LASHANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-465-3534
Mailing Address - Street 1:PO BOX 8764
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32239-0764
Mailing Address - Country:US
Mailing Address - Phone:904-465-3534
Mailing Address - Fax:
Practice Address - Street 1:10316 RED TIP RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-9132
Practice Address - Country:US
Practice Address - Phone:904-465-3534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103847500OtherMEDICAID
FL103847500Medicaid