NPIMap

Organization Active NPI

Supported Living Systems

  • Community/Behavioral Health Agency
  • Tucson, AZ
National Provider Identifier
1356499750
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
BH-2160 Issued in AZ
Legal business name
SUPPORTED LIVING SYSTEMS
Practice address
925 S Craycroft Rd
Tucson, AZ 85711-7112
Phone
(520) 514-9888
Fax
(520) 514-9878
NPI assigned
Jan 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Richard Eck, PHD
Title
Ceo
Phone
(520) 514-9888

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X BH-2160 AZ Primary

Addresses

Primary practice location

925 S Craycroft Rd
Tucson, AZ 85711-7112

Mailing address

925 S Craycroft Rd
Tucson, AZ 85711-7112
Phone (520) 514-9888

Other identifiers 2

IdentifierTypeStateIssuer
BH-2160OtherAZAZ BEHAVIORAL LICENSE #
779647OtherAZAHCCCS PROVIDER #

National Provider Directory

National Provider Directory
Tax ID family
Agape House8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

925 S Craycroft Rd
Tucson, AZ 85711
Phone (520) 514-9888

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1356499750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 S CRAYCROFT RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857117112",
            "telephone_number": "520-514-9888",
            "fax_number": "520-514-9878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 S CRAYCROFT RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857117112",
            "telephone_number": "520-514-9888",
            "fax_number": "520-514-9878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPPORTED LIVING SYSTEMS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ECK",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "520-514-9888",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "AZ",
            "license": "BH-2160",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AZ BEHAVIORAL LICENSE #",
            "identifier": "BH-2160",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS PROVIDER #",
            "identifier": "779647",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.