Provider Demographics
NPI:1194582502
Name:UNITED SUPPORT SERVICES
Entity type:Organization
Organization Name:UNITED SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:929-690-4032
Mailing Address - Street 1:10769 W SADDLEHORN RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-9682
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3930 E RAY RD STE 120
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-7172
Practice Address - Country:US
Practice Address - Phone:602-354-9252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local