NPIMap

Organization Active NPI

Supported Living Systems

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Tucson, AZ
National Provider Identifier
1396893707
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
BH-2615 Issued in AZ
Legal business name
SUPPORTED LIVING SYSTEMS
Practice address
5752 E Waverly St
Tucson, AZ 85712-3739
Phone
(520) 320-0045
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
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X BH-2615 AZ Primary

Addresses

Primary practice location

5752 E Waverly St
Tucson, AZ 85712-3739

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
BH-2615OtherAZAZ BEHAVIORAL LICENSE #
687824OtherAZAHCCCS PROVIDER #

Other names 1

  • Sierra House Other name

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.

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": "1396893707",
    "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": "5752 E WAVERLY ST",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857123739",
            "telephone_number": "520-320-0045"
        }
    ],
    "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": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "AZ",
            "license": "BH-2615",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AZ BEHAVIORAL LICENSE #",
            "identifier": "BH-2615",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS PROVIDER #",
            "identifier": "687824",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sierra House",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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.