Organization
ASUR SUPPORTED LIVING SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAWAIN GORDON JR (MANAGING MEMBER)
(614) 946-5504
Entity
Organization
Contact information
Practice address
5150 E MAIN ST LOWR LEVEL, COLUMBUS, OH 43213-2441
(614) 419-9493
Mailing address
5150 E MAIN ST LOWR LEVEL, COLUMBUS, OH 43213-2441
(614) 419-9493
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Enumeration date
10/31/2025
Last updated
10/31/2025
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