Provider Demographics
NPI:1972120152
Name:ENGAGE SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:ENGAGE SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICO
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MSN,MBA
Authorized Official - Phone:859-687-9291
Mailing Address - Street 1:2526 REGENCY RD STE 140
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2996
Mailing Address - Country:US
Mailing Address - Phone:859-687-9291
Mailing Address - Fax:
Practice Address - Street 1:2526 REGENCY RD STE 140
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2996
Practice Address - Country:US
Practice Address - Phone:859-687-9291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services