Provider Demographics
NPI:1376071217
Name:UNITED SUPPORTIVE SERVICES
Entity Type:Organization
Organization Name:UNITED SUPPORTIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GURPREET
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDHU-GAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-398-7116
Mailing Address - Street 1:1652 W TEXAS ST STE 160
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-6080
Mailing Address - Country:US
Mailing Address - Phone:707-398-6400
Mailing Address - Fax:
Practice Address - Street 1:1652 W TEXAS ST STE 160
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6080
Practice Address - Country:US
Practice Address - Phone:707-398-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17000592253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care