The Supported Living Group, LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

THE SUPPORTED LIVING GROUP, LLC

Practice address

113 School St
Danielson, CT 06239-3022

Phone

(860) 933-6284

Fax

(860) 412-9232

NPI assigned

Nov 29, 2023

Organization subpart

No

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

Authorized official

Name

Kimberly Brisson

Title

Vice President, Coo

Phone

(860) 933-6284

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• The Supported Living Group Other name

Locations

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

{
    "created_epoch": "1701216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701216000000",
    "number": "1962278119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 SCHOOL ST",
            "city": "DANIELSON",
            "state": "CT",
            "postal_code": "062393022",
            "telephone_number": "860-933-6284",
            "fax_number": "860-412-9232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 SCHOOL ST",
            "city": "DANIELSON",
            "state": "CT",
            "postal_code": "062393022",
            "telephone_number": "860-933-6284",
            "fax_number": "860-412-9232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SUPPORTED LIVING GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-29",
        "last_updated": "2023-11-29",
        "certification_date": "2023-11-29",
        "status": "A",
        "authorized_official_last_name": "BRISSON",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "VICE PRESIDENT, COO",
        "authorized_official_telephone_number": "860-933-6284"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008099131",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008101318",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008120112",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008065199",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Supported Living Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 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.