NPIMap

Organization Active NPI

Asur Supported Living Services LLC

  • Home Health Agency
  • Charlotte, NC
National Provider Identifier
1295309136
Registry record updated May 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
ASUR SUPPORTED LIVING SERVICES LLC
Practice address
4328 Canipe Dr
Charlotte, NC 28269-5198
Phone
(855) 519-2787
Fax
(614) 868-1698
NPI assigned
May 15, 2021
Last updated
May 15, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2021

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

Authorized official

Name
Tomika GordonNPI 1881290831
Title
Managing Member
Phone
(614) 795-4422

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X
Home Health Agency 251E00000X Primary
Supports Brokerage Agency 251X00000X
Adult Day Care Clinic/Center 261QA0600X
Developmental Disabilities Clinic/Center 261QD1600X

Addresses

Primary practice location

4328 Canipe Dr
Charlotte, NC 28269-5198

Mailing address

4328 Canipe Dr
Charlotte, NC 28269-5198
Phone (855) 519-2787

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Columbus Direct

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1621036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621036800000",
    "number": "1295309136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4328 CANIPE DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282695198",
            "telephone_number": "855-519-2787",
            "fax_number": "614-868-1698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4328 CANIPE DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282695198",
            "telephone_number": "855-519-2787",
            "fax_number": "614-868-1698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASUR SUPPORTED LIVING SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-15",
        "last_updated": "2021-05-15",
        "certification_date": "2021-05-15",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "TOMIKA",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "614-795-4422"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251X00000X",
            "taxonomy_group": "",
            "desc": "Supports Brokerage",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Columbus",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4328 Canipe Dr",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282695198",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 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.