MEDICARE: SUPPORT SOLUTIONS OF THE MIDSOUTH LLC

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	253Z00000X	In Home Supportive Care Agency
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1568803559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPPORT SOLUTIONS OF THE MIDSOUTH LLC

Provider Business Mailing Address
First Line	:	327 N LOGAN ST
Second Line	:
City	:	MARION
State	:	NC
Zip	:	28752-3700
Country	:	US
Telephone Number	:	866-714-2273
Fax Number	:	877-749-3885

Provider Business Practice Location Address
First Line	:	327 N LOGAN ST
Second Line	:
City	:	MARION
State	:	NC
Zip	:	28752-3700
Country	:	US
Telephone Number	:	866-714-2273
Fax Number	:	877-749-3885

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	DR. LARRY DURBIN
Credential	:	ED. D
Telephone Number	:	901-383-9193

Provider Enumeration Date	:	07/08/2013
Last Update Date	:	09/05/2013

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