Provider Demographics
NPI:1235304874
Name:SUPPORT, INCORPORATED
Entity Type:Organization
Organization Name:SUPPORT, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:ONEAL
Authorized Official - Last Name:KIRKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:303-340-0322
Mailing Address - Street 1:15591 E CENTRETECH PKWY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-9102
Mailing Address - Country:US
Mailing Address - Phone:303-340-0322
Mailing Address - Fax:303-340-0385
Practice Address - Street 1:15591 E CENTRETECH PKWY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-9102
Practice Address - Country:US
Practice Address - Phone:303-340-0322
Practice Address - Fax:303-340-0385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09141383Medicaid
CO09142142Medicaid