Asur Supported Living Services LLC

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

Organization subpart

No

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

Authorized official

Name

Tomika Gordon

Title

Managing Member

Phone

(614) 795-4422

Specialties & licenses 5

Addresses

Electronic endpoints 1

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": []
}

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• 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.