Supportive Care LLC

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

Legal business name

SUPPORTIVE CARE LLC

Practice address

14823 E 12 Mile Rd
Warren, MI 48088-4004

Phone

(586) 252-6974

NPI assigned

Feb 2, 2021

Organization subpart

No

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

Authorized official

Name

Miss Brandi Danielle Watters, PRACTICAL NURSENPI 1568990844

Title

Owner

Phone

(586) 252-6974

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brandi Danielle Watters

  • Licensed Practical Nurse
  • Novi, MI
  • NPI 1568990844
  NPD Authorized official

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

{
    "created_epoch": "1612224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612224000000",
    "number": "1740871763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14823 E 12 MILE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480884004",
            "telephone_number": "586-252-6974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14823 E 12 MILE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480884004",
            "telephone_number": "586-252-6974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPPORTIVE CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-02",
        "last_updated": "2021-02-02",
        "certification_date": "2021-02-02",
        "status": "A",
        "authorized_official_last_name": "WATTERS",
        "authorized_official_first_name": "BRANDI",
        "authorized_official_middle_name": "DANIELLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "586-252-6974",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "PRACTICAL NURSE"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Licensed Practical Nurse",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Licensed Practical Nurse in Warren, MI
• Providers in Warren, MI by specialty
• Licensed Practical Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 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.