Healthcare Provider Details

I. General information

NPI: 1568379535
Provider Name (Legal Business Name): SUPPORTIVE SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12478 E AGAVE LN
FLORENCE AZ
85132-0234
US

IV. Provider business mailing address

8291 W CAMPANELLA WAY
FLORENCE AZ
85132-4015
US

V. Phone/Fax

Practice location:
  • Phone: 602-515-9105
  • Fax: 520-635-5237
Mailing address:
  • Phone: 602-515-9105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KEVIN OWINYO OTIENO
Title or Position: ADMINISTRATOR
Credential:
Phone: 602-515-9105