Provider Demographics
NPI:1821454398
Name:ASSURANCE SUPPORT SERVICES AGENCY
Entity Type:Organization
Organization Name:ASSURANCE SUPPORT SERVICES AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:GORMAH
Authorized Official - Middle Name:PINKY
Authorized Official - Last Name:KOLLEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-888-4813
Mailing Address - Street 1:24789 E FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80018-6054
Mailing Address - Country:US
Mailing Address - Phone:720-420-9049
Mailing Address - Fax:
Practice Address - Street 1:11059 E BETHANY DR STE 105
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2617
Practice Address - Country:US
Practice Address - Phone:720-420-9049
Practice Address - Fax:720-368-5299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-13
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services