SUPREME POSITIVE INNOVATION SERVICES LLC


Address: 1833 W Main St Ste 139-140, Mesa, AZ 85201-6922
Phone: 6027576786

SUPREME POSITIVE INNOVATION SERVICES LLC (NPI# 1215544903) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1215544903
Entity Type Organization
Organization Name SUPREME POSITIVE INNOVATION SERVICES LLC
Practice Address 1833 W Main St Ste 139-140
Mesa
AZ 85201-6922
Practice Telephone 6027576786
Mailing Telephone 6027576786
Enumeration Date 2020-09-26
Last Update Date 2020-09-28
Authorized Official Name KATELYN MARIE TAMAS (MANAGING PARTNER)
Authorized Official Telephone 6027576786
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 261QM0801X Clinic/Center
Specialization: Mental Health (Including Community Mental Health Center)
Ambulatory Health Care Facilities

Office Location

Street Address 1833 W MAIN ST STE 139-140
City MESA
State AZ
Zip Code 85201-6922

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1356711279 Cheryl Agosto Registered Nurse 1025 N. Country Club Dr, Mesa, AZ 85201 2015-10-05
1861877961 Richard Roble Speech-Language Pathologist 125 N. Country Club Dr., Mesa, AZ 85201 2015-07-30
1326440991 Demetria Harris Counselor 455 N. Mesa Drive #11, Mesa, AZ 85201 2014-09-25
1588002489 Zhen Liu Acupuncturist 210n. Center St, #102, Mesa, AZ 85201 2013-06-13
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Taxonomy Information

Taxonomy Code 261QM0801X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Mental Health (Including Community Mental Health Center)

Taxonomy Definition

Definition to come...

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1194285643 Lifeline Professional Counseling Services, Inc Clinic/Center 1423 S Higley Rd Ste 103, Mesa, AZ 85206-3449 2019-03-21
1609334812 Just 1 Life Services LLC Clinic/Center 1616 E Main St Ste 207a.1, Mesa, AZ 85203-9071 2019-03-06
1558682914 Southwest Behavioral Health Services, Inc. Clinic/Center 653 W Guadalupe Rd Unit 1018, Mesa, AZ 85210-7772 2010-06-18
1154954113 Babbitt Bowers Behavioral Health Services. LLC Clinic/Center 605 N Gilbert Rd, Mesa, AZ 85203-6629 2020-02-18
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Competitor

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City MESA
Zip Code 85201

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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