Provider Demographics
NPI:1215166624
Name:SUPPORTED LIVING INC.
Entity type:Organization
Organization Name:SUPPORTED LIVING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PETERS
Authorized Official - Middle Name:
Authorized Official - Last Name:OKOYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-938-1723
Mailing Address - Street 1:7512 KEITH LN
Mailing Address - Street 2:
Mailing Address - City:SACHSE
Mailing Address - State:TX
Mailing Address - Zip Code:75048-2195
Mailing Address - Country:US
Mailing Address - Phone:214-938-1723
Mailing Address - Fax:972-782-2910
Practice Address - Street 1:7512 KEITH LN
Practice Address - Street 2:
Practice Address - City:SACHSE
Practice Address - State:TX
Practice Address - Zip Code:75048-2195
Practice Address - Country:US
Practice Address - Phone:214-938-1723
Practice Address - Fax:972-782-2910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-07
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care