MEDICARE: SUPPORTIVE LIVING SOLUTIONS CORP

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
1	323P00000X	Psychiatric Residential Treatment Facility

General Provider Information

NPI Number	:	1427906270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPPORTIVE LIVING SOLUTIONS CORP

Provider Business Mailing Address
First Line	:	1001 WALNUT ST W
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27893-3027
Country	:	US
Telephone Number	:	252-274-9009
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 WALNUT ST W
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27893-3027
Country	:	US
Telephone Number	:	252-274-9009
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TYRONE GLENN MEJIAS
Credential	:
Telephone Number	:	252-274-9009

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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