Provider Demographics
NPI:1053446559
Name:SUPPORTIVE SERVICES INC.
Entity Type:Organization
Organization Name:SUPPORTIVE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MULTI SERVICE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PASQUALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-843-8802
Mailing Address - Street 1:1314 9TH AVE
Mailing Address - Street 2:PO BOX 758
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-4204
Mailing Address - Country:US
Mailing Address - Phone:724-843-8802
Mailing Address - Fax:
Practice Address - Street 1:528 4TH AVE
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:PA
Practice Address - Zip Code:15066-1720
Practice Address - Country:US
Practice Address - Phone:724-846-4188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA467130320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness