=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013338987
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUPPORT SYSTEMS HOMES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2013
-----------------------------------------------------
Last Update Date | 06/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 173 N. MORRISON AVE
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95126-2712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-370-9688
-----------------------------------------------------
Fax | 408-370-3487
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1202 MERIDIAN AVENUE
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95125-5209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-370-9688
-----------------------------------------------------
Fax | 408-370-3487
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | JENNIFER DOOLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 408-370-9688
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------