Provider Demographics
NPI:1073906582
Name:SUPREME SUPPORT SERVICES, LLC.
Entity Type:Organization
Organization Name:SUPREME SUPPORT SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WOODROW
Authorized Official - Middle Name:
Authorized Official - Last Name:MENTAR
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:803-979-9014
Mailing Address - Street 1:220 N MAIN ST STE 500
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2129
Mailing Address - Country:US
Mailing Address - Phone:803-979-9014
Mailing Address - Fax:
Practice Address - Street 1:220 N MAIN ST STE 500
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-2129
Practice Address - Country:US
Practice Address - Phone:803-979-9014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-08
Last Update Date:2015-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services