Provider Demographics
NPI:1861045239
Name:SUPPORTING SERVICES INTEGRATION, LLC
Entity Type:Organization
Organization Name:SUPPORTING SERVICES INTEGRATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO- DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:240-533-1148
Mailing Address - Street 1:7167 MILL RUN DR
Mailing Address - Street 2:
Mailing Address - City:DERWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20855-1208
Mailing Address - Country:US
Mailing Address - Phone:301-922-6951
Mailing Address - Fax:
Practice Address - Street 1:7167 MILL RUN DR
Practice Address - Street 2:
Practice Address - City:DERWOOD
Practice Address - State:MD
Practice Address - Zip Code:20855-1208
Practice Address - Country:US
Practice Address - Phone:301-922-6951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services