Provider Demographics
NPI:1902404957
Name:SUPPORT SYSTEMS, INC.
Entity Type:Organization
Organization Name:SUPPORT SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:WALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-255-6503
Mailing Address - Street 1:600 S 2ND ST STE 105
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5701
Mailing Address - Country:US
Mailing Address - Phone:701-255-6503
Mailing Address - Fax:701-255-1276
Practice Address - Street 1:600 S 2ND ST STE 105
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5701
Practice Address - Country:US
Practice Address - Phone:701-255-6503
Practice Address - Fax:701-255-1276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-13
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1456245Medicaid