Supportive Homes Inc

Primary specialty

CounselorTaxonomy code 101Y00000X

Legal business name

SUPPORTIVE HOMES INC

Practice address

3702 Larkhaven Village
Charlotte, NC 28215

Phone

(929) 255-7761

NPI assigned

Oct 3, 2021

Organization subpart

No

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

Authorized official

Name

Lateef Cook

Title

President/Ceo

Phone

(929) 255-7761

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1633219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633219200000",
    "number": "1023780533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3702 LARKHAVEN VILLAGE",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3702 LARKHAVEN VILLAGE",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28215",
            "telephone_number": "929-255-7761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPPORTIVE HOMES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-03",
        "last_updated": "2021-10-03",
        "certification_date": "2021-10-03",
        "status": "A",
        "authorized_official_last_name": "COOK",
        "authorized_official_first_name": "LATEEF",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "929-255-7761"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Siddharth P Sura, MD

• Counselor in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2021; 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.