Provider Demographics
NPI:1871771493
Name:SUPPORTIVE SYSTEMS, LLC
Entity type:Organization
Organization Name:SUPPORTIVE SYSTEMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MSSW
Authorized Official - Phone:317-788-4111
Mailing Address - Street 1:25 BEACHWAY DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-8506
Mailing Address - Country:US
Mailing Address - Phone:317-788-4111
Mailing Address - Fax:317-788-7783
Practice Address - Street 1:25 BEACHWAY DR
Practice Address - Street 2:SUITE C
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-8506
Practice Address - Country:US
Practice Address - Phone:317-788-4111
Practice Address - Fax:317-788-7783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001241A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty