Healthcare Provider Details

I. General information

NPI: 1427906270
Provider Name (Legal Business Name): SUPPORTIVE LIVING SOLUTIONS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 WALNUT ST W
WILSON NC
27893-3027
US

IV. Provider business mailing address

1001 WALNUT ST W
WILSON NC
27893-3027
US

V. Phone/Fax

Practice location:
  • Phone: 252-274-9009
  • Fax:
Mailing address:
  • Phone: 252-274-9009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: TYRONE GLENN MEJIAS
Title or Position: PRESIDENT
Credential:
Phone: 252-274-9009