Provider Demographics
NPI:1619594579
Name:SUSTAINABLE LIVING SUPPORT SERVICES, LLC
Entity type:Organization
Organization Name:SUSTAINABLE LIVING SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAREY
Authorized Official - Middle Name:DANEAL
Authorized Official - Last Name:PYLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-572-1350
Mailing Address - Street 1:869 HOGARDS CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-8871
Mailing Address - Country:US
Mailing Address - Phone:270-572-1350
Mailing Address - Fax:
Practice Address - Street 1:869 HOGARDS CHAPEL RD
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-8871
Practice Address - Country:US
Practice Address - Phone:270-572-1350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities