Provider Demographics
NPI:1003456377
Name:AGENCY FOR EMPOWERMENT & SUPPORT, LLC
Entity Type:Organization
Organization Name:AGENCY FOR EMPOWERMENT & SUPPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:BACHELOR'S DEGREE
Authorized Official - Phone:240-277-8688
Mailing Address - Street 1:581 N PARK AVE UNIT 2791
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32704-8720
Mailing Address - Country:US
Mailing Address - Phone:240-277-8688
Mailing Address - Fax:407-814-8767
Practice Address - Street 1:507 LANCER OAK DR
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-2762
Practice Address - Country:US
Practice Address - Phone:407-814-8767
Practice Address - Fax:407-814-8767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities