Provider Demographics
NPI:1053202291
Name:SUPPORTED LIVING SOLUTIONS
Entity type:Organization
Organization Name:SUPPORTED LIVING SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:QIDP
Authorized Official - Phone:626-848-5990
Mailing Address - Street 1:7380 S EASTERN AVE STE 124
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-1502
Mailing Address - Country:US
Mailing Address - Phone:626-848-5990
Mailing Address - Fax:
Practice Address - Street 1:6320 MCLEOD DR STE 7
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-4427
Practice Address - Country:US
Practice Address - Phone:626-848-5990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Single Specialty