Provider Demographics
NPI:1568150696
Name:DIVERSITY SUPPORT INC
Entity Type:Organization
Organization Name:DIVERSITY SUPPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MMATSEKE
Authorized Official - Middle Name:META AMELIA JESSICA
Authorized Official - Last Name:MAMPANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-741-2833
Mailing Address - Street 1:19981 E 59TH PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80019-2025
Mailing Address - Country:US
Mailing Address - Phone:347-741-2833
Mailing Address - Fax:
Practice Address - Street 1:19981 E 59TH PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80019-2025
Practice Address - Country:US
Practice Address - Phone:347-741-2833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services