MEDICARE: SUPPORTED LIVING SOLUTIONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	373H00000X	Day Training/Habilitation Specialist
2	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1053202291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPPORTED LIVING SOLUTIONS

Provider Business Mailing Address
First Line	:	7380 S EASTERN AVE STE 124
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-1502
Country	:	US
Telephone Number	:	626-848-5990
Fax Number	:

Provider Business Practice Location Address
First Line	:	6320 MCLEOD DR STE 7
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-4427
Country	:	US
Telephone Number	:	626-848-5990
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MICHAEL FRIEDMAN
Credential	:	QIDP
Telephone Number	:	626-848-5990

Provider Enumeration Date	:	07/15/2025
Last Update Date	:	07/15/2025

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Directions to “SUPPORTED LIVING SOLUTIONS ” Practice Location

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