Healthcare Provider Details

I. General information

NPI: 1548601545
Provider Name (Legal Business Name): SUPPORT SOLUTIONS OF THE MIDSOUTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 N MAIN ST
BURNSVILLE NC
28714-2925
US

IV. Provider business mailing address

24 N MAIN ST
BURNSVILLE NC
28714-2925
US

V. Phone/Fax

Practice location:
  • Phone: 828-682-2220
  • Fax: 877-749-3885
Mailing address:
  • Phone: 828-682-2220
  • Fax: 877-749-3885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. LARRY DURBIN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: ED.D
Phone: 901-383-9193