Provider Demographics
NPI:1851795660
Name:SUPAID COMMUNITY RESOURCES, INC.
Entity Type:Organization
Organization Name:SUPAID COMMUNITY RESOURCES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/DDP
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DDP
Authorized Official - Phone:678-763-6722
Mailing Address - Street 1:750 JAMESTOWN XING
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30238-4384
Mailing Address - Country:US
Mailing Address - Phone:678-610-7255
Mailing Address - Fax:678-610-7255
Practice Address - Street 1:750 JAMESTOWN XING
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30238-4384
Practice Address - Country:US
Practice Address - Phone:678-610-7255
Practice Address - Fax:678-610-7255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2014-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)