Provider Demographics
NPI:1033205588
Name:SUPPORT SYSTEMS HOMES, INC.
Entity Type:Organization
Organization Name:SUPPORT SYSTEMS HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:TO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-370-9688
Mailing Address - Street 1:1925 S WINCHESTER BLVD
Mailing Address - Street 2:#204
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-1037
Mailing Address - Country:US
Mailing Address - Phone:408-370-9688
Mailing Address - Fax:408-370-0337
Practice Address - Street 1:264 N MORRISON AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2741
Practice Address - Country:US
Practice Address - Phone:408-885-1003
Practice Address - Fax:408-885-1024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility