Provider Demographics
NPI:1265138770
Name:NOTTUS SUPPORT SOLUTIONS
Entity type:Organization
Organization Name:NOTTUS SUPPORT SOLUTIONS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-336-3039
Mailing Address - Street 1:15055 FAIRFIELD MEADOWS DR
Mailing Address - Street 2:STE 130-85
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-5394
Mailing Address - Country:US
Mailing Address - Phone:346-336-3039
Mailing Address - Fax:832-219-7757
Practice Address - Street 1:15011 MILLER MEADOWS LN
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-4422
Practice Address - Country:US
Practice Address - Phone:346-336-3039
Practice Address - Fax:832-219-7757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No251X00000XAgenciesSupports BrokerageGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1750092755Medicaid