Provider Demographics
NPI:1538923412
Name:SINCERE OPEN SUPPORT SERVICES LLC
Entity type:Organization
Organization Name:SINCERE OPEN SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANGELICA
Authorized Official - Last Name:CONGRESS-JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-885-9049
Mailing Address - Street 1:5164 E 81ST AVE STE 237
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5852
Mailing Address - Country:US
Mailing Address - Phone:219-885-9049
Mailing Address - Fax:
Practice Address - Street 1:5164 E 81ST AVE STE 237
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5852
Practice Address - Country:US
Practice Address - Phone:219-885-9049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty