Provider Demographics
NPI:1083801351
Name:KALEO SUPPORT, INC.
Entity Type:Organization
Organization Name:KALEO SUPPORT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:P
Authorized Official - Last Name:SZYMKOWIAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-630-2255
Mailing Address - Street 1:3718 GOLFVIEW RD
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-2818
Mailing Address - Country:US
Mailing Address - Phone:910-322-2755
Mailing Address - Fax:910-339-2808
Practice Address - Street 1:302 MASON ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5006
Practice Address - Country:US
Practice Address - Phone:910-630-2255
Practice Address - Fax:910-339-2808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251C00000X
251S00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418487Medicaid