Provider Demographics
NPI:1144896887
Name:PRO SUPPORT SERVICES LLC
Entity type:Organization
Organization Name:PRO SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-551-6734
Mailing Address - Street 1:21625 CHAGRIN BLVD STE 260
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5363
Mailing Address - Country:US
Mailing Address - Phone:216-551-6734
Mailing Address - Fax:216-373-6565
Practice Address - Street 1:21625 CHAGRIN BLVD STE 260
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5363
Practice Address - Country:US
Practice Address - Phone:216-551-6734
Practice Address - Fax:216-373-6565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization