SUPPORTED LIVING AND EMPLOYMENT SERVICES, INC.
Complete NPI Record 1386022101
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Springfield, MO
Active since May 13, 2015
Complete NPI Dataset
This page contains the complete raw NPPES record for Supported Living And Employment Services, Inc. (NPI 1386022101), a community based residential treatment facility, intellectual and/or developmental disabilities organization in Springfield, MO. All 35 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1386022101 Field 1/35
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 2 Field 2/35
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Employer Identification Number EIN: Not available Field 3/35
- The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
- Provider Organization Name Legal Business Name: SUPPORTED LIVING AND EMPLOYMENT SERVICES, INC. Field 4/35
- The name of the organization provider. If the provider is an organization, this is the legal business name.
- Provider First Line Business Mailing Address: 1111 S GLENSTONE AVE STE 3-100 Field 5/35
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: SPRINGFIELD Field 6/35
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: MO Field 7/35
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 658040397 Field 8/35
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 9/35
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 4178698911 Field 10/35
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider Business Mailing Address Fax Number: 4178643087 Field 11/35
- The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
- Provider First Line Business Practice Location Address: 2885 W BATTLEFIELD ST Field 12/35
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: SPRINGFIELD Field 13/35
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: MO Field 14/35
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 658073952 Field 15/35
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 16/35
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 4178698911 Field 17/35
- The telephone number associated with the location address of the provider being identified.
- Authorized Official Last Name: CARTER Field 20/35
- The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
- Authorized Official First Name: AMANDA Field 21/35
- The first name of the authorized official.
- Authorized Official Middle Name: R Field 22/35
- The middle name of the authorized official.
- Authorized Official Title or Position: VICE PRESIDENT, MANAGED CARE Field 23/35
- The title or position of the authorized official.
- Authorized Official Telephone Number: 4177615126 Field 24/35
- The 10-position telephone number of the authorized official.
- Healthcare Provider Taxonomy Code 1: 251S00000X Field 25/35
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 1: N Field 26/35
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 2: 320900000X Field 27/35
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Provider License Number 2: CC01430115 Field 28/35
- The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".
- Provider License Number State Code 2: MO Field 29/35
- The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.
- Healthcare Provider Primary Taxonomy Switch 2: Y Field 30/35
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Other Provider Identifier 1: 853297406 Field 31/35
- An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
- Other Provider Identifier Type Code 1: 05 Field 32/35
- A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
- Other Provider Identifier State 1: MO Field 33/35
- The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
- Is Organization Subpart: N Field 34/35
- Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
Other Organization Names 1
Additional business and trade names this provider has on file with the NPPES registry.
Firefly Doing Business As
Name 1/1Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.
Secondary Practice Locations 20
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
2400 Independence Sq
Location 1/20West Plains, MO 65775-4229 · Phone (417) 257-1545
926 N Business Route 5
Location 2/20Camdenton, MO 65020-2648 · Phone (573) 346-2487
1208 E State Route 72
Location 3/20Rolla, MO 65401-3938 · Phone (573) 341-2606
1111 S Glenstone Ave Ste 3-100
Location 4/20Springfield, MO 65804-0397 · Phone (417) 869-8911 · Fax (417) 864-3087
7 Westowne St
Location 5/20Liberty, MO 64068-1166 · Phone (417) 884-3008
1103 Weber Rd
Location 6/20Farmington, MO 63640-3345 · Phone (800) 587-2539
2000 S Maiden Ln
Location 7/20Joplin, MO 64804-0343 · Phone (417) 659-9911
111 N Elm St
Location 8/20Nevada, MO 64772-2609 · Phone (417) 667-2233
1333 NW Vivion Rd Ste 200
Location 9/20Kansas City, MO 64118-4535 · Phone (816) 353-2750
141 Communication Dr
Location 10/20Hannibal, MO 63401-3670 · Phone (573) 603-1460
710 S Maiden Ln
Location 11/20Joplin, MO 64801-3802 · Phone (417) 626-0008
6220 Blue Ridge Cutoff Ste 300
Location 12/20Raytown, MO 64133-3730 · Phone (816) 326-8400
7710 E 102nd St
Location 13/20Kansas City, MO 64134-2013 · Phone (816) 595-6365
302 E Dyer St Ste 102
Location 14/20Aurora, MO 65605-8803 · Phone (417) 678-0123
4745 S 131st Rd
Location 15/20Bolivar, MO 65613-2886 · Phone (417) 761-6010
700 E Hospital Rd
Location 16/20El Dorado Springs, MO 64744-2315 · Phone (417) 876-8112
2981 Kanell Blvd
Location 17/20Poplar Bluff, MO 63901-4008 · Phone (573) 776-1941
801 Westchester Ave
Location 18/20Harrisonville, MO 64701-1784 · Phone (816) 884-3008
2626 W College Rd
Location 19/20Springfield, MO 65802-4637 · Phone (417) 869-8086
3105 Independence St Ste B
Location 20/20Cape Girardeau, MO 63703-5042 · Phone (573) 334-4477
Other Provider Identifiers 1
Legacy and payer-issued identifiers reported to the NPPES registry for this provider.
853297406 Medicaid
Identifier 1/1State: MO
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
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