SUPPORTIVE LIVING SERVICES, INC. (NPI# 1346374063) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346374063 |
| Entity Type | Organization |
| Organization Name | SUPPORTIVE LIVING SERVICES, INC. |
| Practice Address |
5615 Brooklyn Blvd Ste 200 Brooklyn Center MN 55429-3086 |
| Practice Telephone | 7635376612 |
| Mailing Telephone | 7635376612 |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2013-05-24 |
| Authorized Official Name | DIANE M OLLENDICK WRIGHT (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 7632771038 |
| Authorized Official Credential | LICSW |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | MN | Agencies |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205900305 | Supportive Living Services, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 210 E 2nd St, Erie, PA 16507-1559 | 2006-11-20 |
| 1467638379 | Supportive Living Services, Inc. | Community/Behavioral Health | 5615 Brooklyn Blvd Ste 200, Brooklyn Center, MN 55429-3086 | 2008-01-10 |
| 1417081704 | Supportive Living Services, Inc. | Community/Behavioral Health | 5615 Brooklyn Blvd Ste 200, Brooklyn Center, MN 55429-3086 | 2007-03-16 |
| Street Address |
5615 BROOKLYN BLVD STE 200 |
| City | BROOKLYN CENTER |
| State | MN |
| Zip Code | 55429-3086 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467638379 | Supportive Living Services, Inc. | Community/Behavioral Health | 5615 Brooklyn Blvd Ste 200, Brooklyn Center, MN 55429-3086 | 2008-01-10 |
| 1093999062 | Michael Elliot Falck | Social Worker | 5615 Brooklyn Blvd Ste 200, Brooklyn Center, MN 55429-3086 | 2007-12-26 |
| 1801015979 | Laura Kahler Loftness | Social Worker | 5615 Brooklyn Blvd Ste 200, Brooklyn Center, MN 55429-3086 | 2007-04-25 |
| 1154540383 | Diane M Ollendick Wright | Social Worker | 5615 Brooklyn Blvd Ste 200, Brooklyn Center, MN 55429-3086 | 2007-04-25 |
| 1053530113 | Thomas R. Alf | Social Worker | 5615 Brooklyn Blvd Ste 200, Brooklyn Center, MN 55429-3086 | 2007-04-25 |
| 1417081704 | Supportive Living Services, Inc. | Community/Behavioral Health | 5615 Brooklyn Blvd Ste 200, Brooklyn Center, MN 55429-3086 | 2007-03-16 |
| 1194859876 | Jeffrey C Alberts | Social Worker | 5615 Brooklyn Blvd Ste 200, Brooklyn Center, MN 55429-3086 | 2007-03-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245852979 | Comfort Home Care | Home Health | 5950 Beard Ave N, Brooklyn Center, MN 55429 | 2020-05-15 |
| 1205300969 | Rescare Minnesota, Inc. | Community Based Residential Treatment Facility, Mental Illness | 4835-4901 West Boradway Avenue, Crystal, MN 55429 | 2019-01-16 |
| 1780156208 | Crescent Cove | Pediatrics | 4201 58th Avd N., Brooklyn Center, MN 55429 | 2018-12-21 |
| 1184106254 | Rescare Minnesota, Inc. | Community Based Residential Treatment Facility, Mental Illness | 4835-4901 W. Broadway Ave, Crystal, MN 55429 | 2018-09-05 |
| 1952889073 | Kelly Mcgregory Pediatrics LLC | Pediatrics | 6000 Bass Lake Rd Ste 102, Crystal, MN 55429 | 2018-07-31 |
| 1023510526 | Family Trust Home Health, LLC | Home Health | 5901 Brooklyn Blvd Ste 201, Brooklyn Center, MN 55429 | 2018-03-01 |
| 1962910588 | Yer Yang | Massage Therapist | 5531 Orchard Ave N, Crystal, MN 55429 | 2018-01-17 |
| 1790203347 | Akeya Bolden | Counselor | 3212 64th Ave N, Brooklyn Center, MN 55429 | 2017-09-05 |
| 1386169316 | Sadia Pauletta Kruah | Transportation Broker | 6756 Grimes Pl North, Brooklyn Center, MN 55429 | 2017-08-10 |
| 1982134904 | Chad Geyen | Marriage & Family Therapist | 3300 County Rd. 10, Brooklyn Center, MN 55429 | 2017-06-13 |
| Find all providers in zip 55429 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033775879 | Skyblu Residential Services | Community/Behavioral Health | 3300 County Road 10 Ste 104, Brooklyn Center, MN 55429-3064 | 2019-05-17 |
| 1275094526 | Affinity Community Health Services, Inc | Community/Behavioral Health | 5701 Shingle Creek Pkwy Ste 240, Brooklyn Center, MN 55430-2332 | 2019-03-28 |
| 1093297368 | Strive Home Care LLC | Community/Behavioral Health | 3300 County Road 10 Ste 512d, Brooklyn Center, MN 55429-3068 | 2018-09-04 |
| 1326556143 | Comfort Therapeutic Services LLC | Community/Behavioral Health | 5701 Shingle Creek Pkwy Ste 661, Brooklyn Center, MN 55430-2486 | 2018-01-15 |
| 1508309162 | Universal Support Agency, LLC. | Community/Behavioral Health | 4513 Winchester Ln, Brooklyn Center, MN 55429-1725 | 2016-11-29 |
| 1457807026 | Livingwell Support Services | Community/Behavioral Health | 3300 County Road D, Brooklyn Center, MN 55429 | 2016-09-01 |
| 1649628561 | Tranquility Health LLC | Community/Behavioral Health | 6040 Earle Brown Dr Ste 250, Brooklyn Center, MN 55430 | 2016-06-01 |
| 1629198965 | Northwest Residence, Inc. | Community/Behavioral Health | 4408 69th Ave N, Brooklyn Center, MN 55429-1739 | 2007-03-30 |
| 1780143909 | Rescare Minnesota, Inc. | Community/Behavioral Health | 6120 Earle Brown Dr Ste 100, Brooklyn Center, MN 55430-4100 | 2019-03-18 |
| 1881196830 | Rescare Minnesota, Inc. | Community/Behavioral Health | 6120 Earle Brown Dr Ste 100, Brooklyn Center, MN 55430-4100 | 2018-03-06 |
| Find all providers in BROOKLYN CENTER | ||||
| City | BROOKLYN CENTER |
| Zip Code | 55429 |
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| 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.