Provider Demographics
NPI:1417072687
Name:EHS SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:EHS SUPPORT SERVICES, LLC
Other - Org Name:EHS, EMBRACE HEALTHY SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:CLINGENPEEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-339-9195
Mailing Address - Street 1:601 CAMPBELL AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-3531
Mailing Address - Country:US
Mailing Address - Phone:540-339-9195
Mailing Address - Fax:540-339-9197
Practice Address - Street 1:601 CAMPBELL AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-3531
Practice Address - Country:US
Practice Address - Phone:540-339-9195
Practice Address - Fax:540-339-9197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA717251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010145023Medicaid