Healthcare Provider Details

I. General information

NPI: 1386022101
Provider Name (Legal Business Name): SUPPORTED LIVING AND EMPLOYMENT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2885 W BATTLEFIELD ST
SPRINGFIELD MO
65807-3952
US

IV. Provider business mailing address

1111 S GLENSTONE AVE STE 3-100
SPRINGFIELD MO
65804-0397
US

V. Phone/Fax

Practice location:
  • Phone: 417-869-8911
  • Fax:
Mailing address:
  • Phone: 417-869-8911
  • Fax: 417-864-3087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberCC01430115
License Number StateMO

VIII. Authorized Official

Name: AMANDA R CARTER
Title or Position: VICE PRESIDENT, MANAGED CARE
Credential:
Phone: 417-761-5126