Active NPI
Supreme Living LLC
- Community/Behavioral Health Agency
- Olympia, WA
National Provider Identifier
1154085181
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Behavioral Health Agency
- Legal business name
- SUPREME LIVING LLC
- Practice address
- 6604 Martin Way E
Olympia, WA 98516 - Phone
- (360) 362-7002
- NPI assigned
- Oct 26, 2021
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Angela M Rinaldo, MA
- Title
- Ceo
- Phone
- (360) 639-7002
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Primary |
Addresses
Primary practice location
6604 Martin Way E
Olympia, WA 98516
Mailing address
1420 Marvin Road NE
Ste C-347
Lacey, WA 98516
Phone (206) 947-4353
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2171006 | Medicaid | WA |
National Provider Directory
National Provider Directory- Tax ID family
- Supreme Living LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community/Behavioral Health Agency
- Olympia, WA
- NPI 1275267049
Locations
1420 Marvin Rd NE
Ste C347
Lacey, WA 98516
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Mental Health Counselor
- Seattle, WA
- NPI 1962787358
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1635206400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1652918400000",
"number": "1154085181",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1420 MARVIN ROAD NE",
"address_2": "STE C-347",
"city": "LACEY",
"state": "WA",
"postal_code": "98516",
"telephone_number": "206-947-4353"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6604 MARTIN WAY E",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "98516",
"telephone_number": "360-362-7002"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SUPREME LIVING LLC",
"organizational_subpart": "NO",
"enumeration_date": "2021-10-26",
"last_updated": "2022-05-19",
"certification_date": "2022-05-19",
"status": "A",
"authorized_official_last_name": "RINALDO",
"authorized_official_first_name": "ANGELA",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "360-639-7002",
"authorized_official_credential": "MA"
},
"taxonomies": [
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2171006",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Olympia, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.