Healthcare Provider Details

I. General information

NPI: 1538625801
Provider Name (Legal Business Name): SUPPORTED SOLUTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 SW GRAHAM ST
SEATTLE WA
98136-1440
US

IV. Provider business mailing address

4414 SW GRAHAM ST
SEATTLE WA
98136-1440
US

V. Phone/Fax

Practice location:
  • Phone: 806-410-0717
  • Fax:
Mailing address:
  • Phone: 806-410-0717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANDREW HARMAN
Title or Position: CEO
Credential:
Phone: 806-410-0717