Provider Demographics
NPI:1699542480
Name:SUPPORTIVE SOLUTIONS LLC
Entity type:Organization
Organization Name:SUPPORTIVE SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:OWINYO
Authorized Official - Last Name:OTIENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-515-9105
Mailing Address - Street 1:8291 W CAMPANELLA WAY
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85132-4015
Mailing Address - Country:US
Mailing Address - Phone:602-515-9105
Mailing Address - Fax:
Practice Address - Street 1:8291 W CAMPANELLA WAY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85132-4015
Practice Address - Country:US
Practice Address - Phone:602-515-9105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health