Provider Demographics
NPI:1891052049
Name:SUPPORTIVE LIVING SOULTIONS,LLC
Entity Type:Organization
Organization Name:SUPPORTIVE LIVING SOULTIONS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FRAHM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-234-0594
Mailing Address - Street 1:255 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2117
Mailing Address - Country:US
Mailing Address - Phone:651-222-7587
Mailing Address - Fax:651-222-5341
Practice Address - Street 1:255 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2117
Practice Address - Country:US
Practice Address - Phone:651-222-7587
Practice Address - Fax:651-222-5341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN356379251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health