Healthcare Provider Details

I. General information

NPI: 1053202291
Provider Name (Legal Business Name): SUPPORTED LIVING SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6320 MCLEOD DR STE 7
LAS VEGAS NV
89120-4427
US

IV. Provider business mailing address

7380 S EASTERN AVE STE 124
LAS VEGAS NV
89123-1502
US

V. Phone/Fax

Practice location:
  • Phone: 626-848-5990
  • Fax:
Mailing address:
  • Phone: 626-848-5990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL FRIEDMAN
Title or Position: DIRECTOR
Credential: QIDP
Phone: 626-848-5990