Provider Demographics
NPI:1841001195
Name:DIRECT SUPPORT PROFESSIONALS, LLC
Entity type:Organization
Organization Name:DIRECT SUPPORT PROFESSIONALS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FUTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-298-7075
Mailing Address - Street 1:9404 SUNSET CT APT 423
Mailing Address - Street 2:
Mailing Address - City:MANASSAS PARK
Mailing Address - State:VA
Mailing Address - Zip Code:20111-8294
Mailing Address - Country:US
Mailing Address - Phone:571-298-7075
Mailing Address - Fax:
Practice Address - Street 1:5248 OLDE TOWNE RD STE 6
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-1986
Practice Address - Country:US
Practice Address - Phone:757-800-7028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care