Provider Demographics
NPI:1316188964
Name:YOUR SUPPORTIVE SERVICES, LLC
Entity Type:Organization
Organization Name:YOUR SUPPORTIVE SERVICES, LLC
Other - Org Name:YOUR SUPPORTIVE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:HUML
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:208-339-4902
Mailing Address - Street 1:PO BOX 341
Mailing Address - Street 2:343 E 4TH N SUITE 121
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-0341
Mailing Address - Country:US
Mailing Address - Phone:208-339-4902
Mailing Address - Fax:208-359-0082
Practice Address - Street 1:343 E 4TH N STE 121
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-6004
Practice Address - Country:US
Practice Address - Phone:208-339-4902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-11
Last Update Date:2009-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health