Supportive Living Services, Inc.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

SUPPORTIVE LIVING SERVICES, INC.

Practice address

5615 Brooklyn Blvd Ste 200
Brooklyn Center, MN 55429-3086

Phone

(763) 537-6612

NPI assigned

Mar 15, 2007

Organization subpart

No

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

Authorized official

Name

Diane M Ollendick Wright, LICSW

Title

Executive Director

Phone

(763) 277-1038

Specialties & licenses 1

Addresses

Tax ID family

Supportive Living Services Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Supportive Living Services, Inc.

  • Community/Behavioral Health Agency
  • Brooklyn Center, MN
  • NPI 1467638379
  NPD tax ID

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369353600000",
    "number": "1346374063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5615 BROOKLYN BLVD STE 200",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554293086",
            "telephone_number": "763-537-6612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5615 BROOKLYN BLVD STE 200",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554293086",
            "telephone_number": "763-537-6612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPPORTIVE LIVING SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2013-05-24",
        "status": "A",
        "authorized_official_last_name": "OLLENDICK WRIGHT",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "763-277-1038",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sun Pharmacy Inc
• Sunset Home Healthcare LLC
• Sunshine Supportive Services
• Sunshine Supportive Services
• Supervalu Pharmacies Inc
• Supportive Living Services, Inc.
• Supportive Living Services, Inc.
• Nathan Susman, LGSW
• Bruce Swain
• Randy Judd Swanson, LICSW

• Community/Behavioral Health Agency in Brooklyn Center, MN
• Providers in Brooklyn Center, MN by specialty
• Community/Behavioral Health Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2013; 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.