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NPI Code Detail

MEDICARE: SUPREME SUPPORT SERVICES, LLC.

MEDICARE: SUPREME SUPPORT SERVICES, LLC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251B00000XCase Management Agency
2251C00000XDevelopmentally Disabled Services Day Training Agency
3251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1073906582
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUPREME SUPPORT SERVICES, LLC.
Provider Business Mailing Address
First Line : 220 N MAIN ST STE 500
Second Line :
City : GREENVILLE
State : SC
Zip : 29601-2129
Country : US
Telephone Number : 803-979-9014
Fax Number :
Provider Business Practice Location Address
First Line : 220 N MAIN ST STE 500
Second Line :
City : GREENVILLE
State : SC
Zip : 29601-2129
Country : US
Telephone Number : 803-979-9014
Fax Number :
Authorized Official
Title or Position : MANAGING PARTNER
Name : MR. WOODROW MENTAR JR.
Credential :
Telephone Number : 803-979-9014
Provider Enumeration Date : 03/08/2015
Last Update Date : 03/08/2015

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Directions to “SUPREME SUPPORT SERVICES, LLC. ” Practice Location

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