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Organization
ASUR SUPPORTED LIVING SERVICES LLC
Active
Organization
ASUR SUPPORTED LIVING SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TOMIKA GORDON (MANAGING MEMBER)
(614) 795-4422
Entity
Organization
Contact information
Practice address
4328 CANIPE DR, CHARLOTTE, NC 28269-5198
(855) 519-2787
(614) 868-1698
Mailing address
4328 CANIPE DR, CHARLOTTE, NC 28269-5198
(855) 519-2787
(614) 868-1698
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251E00000X
Home Health Agency
Primary
—
—
251X00000X
Supports Brokerage Agency
—
—
261QA0600X
Adult Day Care Clinic/Center
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
Other
Enumeration date
05/15/2021
Last updated
05/15/2021
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