Organization
SUPREME LIVING LLC
Active
Organization
SUPREME LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA M RINALDO MA (CEO)
(360) 639-7002
Entity
Organization
Contact information
Practice address
6604 MARTIN WAY E, OLYMPIA, WA 98516
(360) 362-7002
Mailing address
1420 MARVIN ROAD NE, STE C-347, LACEY, WA 98516
(206) 947-4353
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2171006
—
WA
Enumeration date
10/26/2021
Last updated
05/19/2022
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