| Supreme Living Llc | |
|
6604 Martin Way E Olympia WA 98516 | |
| (360) 362-7002 | |
| Not Available |
| Full Name | Supreme Living Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 6604 Martin Way E, Olympia, Washington |
| Authorized Official Name and Position | Angela M Rinaldo (CEO) |
| Authorized Official Contact | 3606397002 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Supreme Living Llc 1420 Marvin Road Ne Ste C-347 Lacey WA 98516 Ph: (206) 947-4353 | Supreme Living Llc 6604 Martin Way E Olympia WA 98516 Ph: (360) 362-7002 |
| NPI Number | 1154085181 |
|---|---|
| Provider Enumeration Date | 10/26/2021 |
| Last Update Date | 05/19/2022 |
| Certification Date | 05/19/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154085181 | NPI | - | NPPES |
| 2171006 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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