| Organization Name: | SUPPORTING PROVIDER SERVICES |
| NPI Number: | 1114393527 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | THERESA BUFORD (VOCATIONAL REHABILITATION) |
| Mailing Address: | 8330 S Wynona Ct Oak Creek |
| State: | WI US |
| Postal Code: | 531542740 |
| Phone Number: | 2625271282 |
| Fax Number: | |
| NPI Enumeration Date: | 08/19/2015 |
| NPI Last Update Date: | 08/19/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 385HR2065X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Respite Care Facility |
| Taxonomy Classification: | Respite Care |
| Taxonomy Specialization: | Respite Care, Physical Disabilities, Child |
| Taxonomy Definition: | A facility or distinct part of a facility that providers short term, residential care to children, diagnosed with complex or profound disabilities as respite for the regular caregivers. |