Provider Demographics
NPI:1366910598
Name:ASPIRE SUPPORTS
Entity type:Organization
Organization Name:ASPIRE SUPPORTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KARL
Authorized Official - Middle Name:JERSON
Authorized Official - Last Name:VENESCAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-440-0802
Mailing Address - Street 1:PO BOX 392
Mailing Address - Street 2:
Mailing Address - City:MC AFEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07428-0392
Mailing Address - Country:US
Mailing Address - Phone:973-440-0802
Mailing Address - Fax:973-965-9559
Practice Address - Street 1:40 ROUTE 94
Practice Address - Street 2:UNIT 392 / L1
Practice Address - City:MCAFEE
Practice Address - State:NJ
Practice Address - Zip Code:07428
Practice Address - Country:US
Practice Address - Phone:973-440-0802
Practice Address - Fax:973-965-9559
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASPIRE SUPPORT COORDINATION, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-06
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0630683Medicaid