Supporting Community Independence

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

SUPPORTING COMMUNITY INDEPENDENCE

Practice address

1 Polo Grounds CT
Bethalto, IL 62010-2623

Phone

(618) 806-4344

NPI assigned

Mar 3, 2020

Last updated

Mar 3, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Elizabeth Ann Sahuri, QIDP,RN

Title

Ceo

Phone

(618) 806-4344

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1583193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583193600000",
    "number": "1023643772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 POLO GROUNDS CT",
            "city": "BETHALTO",
            "state": "IL",
            "postal_code": "620102623",
            "telephone_number": "618-806-4344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 POLO GROUNDS CT",
            "city": "BETHALTO",
            "state": "IL",
            "postal_code": "620102623",
            "telephone_number": "618-806-4344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPPORTING COMMUNITY INDEPENDENCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-03",
        "last_updated": "2020-03-03",
        "certification_date": "2020-03-03",
        "status": "A",
        "authorized_official_last_name": "SAHURI",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "618-806-4344",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "QIDP,RN"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Bethalto, IL
• Providers in Bethalto, IL by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.