Supportive Independent Lifestyle LLC

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

Legal business name

SUPPORTIVE INDEPENDENT LIFESTYLE LLC

Doing business as

Independent Lifestyles LLC

Practice address

316 Office Square LN Ste 101
Virginia Beach, VA 23462-3651

Phone

(757) 383-2589

NPI assigned

May 10, 2023

Organization subpart

No

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

Authorized official

Name

Mr. Adam Harris

Title

Ceo

Phone

(757) 383-2589

Specialties & licenses 1

Addresses

Other names 1

• Independent Lifestyles LLC Doing business as

Locations

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

{
    "created_epoch": "1683676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683676800000",
    "number": "1780374033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "316 OFFICE SQUARE LN STE 101",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234623651",
            "telephone_number": "757-383-2589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 OFFICE SQUARE LN STE 101",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234623651",
            "telephone_number": "757-383-2589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPPORTIVE INDEPENDENT LIFESTYLE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-10",
        "last_updated": "2023-05-10",
        "certification_date": "2023-05-10",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "757-383-2589",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Independent Lifestyles LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Developmentally Disabled Services Day Training Agency in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Developmentally Disabled Services Day Training Agency in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2023; 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.