Provider Demographics
NPI:1508136730
Name:SUPPORTIVE HEALTHCARE SERVICES INC.
Entity Type:Organization
Organization Name:SUPPORTIVE HEALTHCARE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTHCARE PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLUWATOYIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADENIYI
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:469-951-9274
Mailing Address - Street 1:P.O. BOX 380971
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75138
Mailing Address - Country:US
Mailing Address - Phone:682-422-3441
Mailing Address - Fax:
Practice Address - Street 1:508 STILES DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-4536
Practice Address - Country:US
Practice Address - Phone:682-422-3441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX640034363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty