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General NPI Number Information
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NPI Number | 1578271151
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Entity Type | Organization
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Legal Business Name | PURE SUPPORT LLC
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Dates
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Enumeration Date | 11/11/2022
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Last Update Date | 12/16/2022
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Provider Practice Location Address
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Address Line | 3770 COUNTY ROAD F N
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City | DELAVAN
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State | WI
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Zip | 53115-2963
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Country | US
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Telephone | 262-203-0247
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Fax |
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Provider Business Mailing Address
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Address Line | 3770 COUNTY ROAD F N
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City | DELAVAN
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State | WI
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Zip | 53115-2963
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Country | US
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Telephone | 262-203-0247
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Fax |
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Authorized Official
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Title or Position | MEMBER, MANAGER, FOUNDER
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Name | MITCHELL SHERMAN
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Credential | CPS
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Telephone | 262-203-0247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 225800000X
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Taxonomy Name | Recreation Therapist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 374K00000X
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Taxonomy Name | Religious Nonmedical Practitioner
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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