Provider Demographics
NPI:1588353767
Name:UNIVERSAL SUPPORT AGENCY LLC
Entity type:Organization
Organization Name:UNIVERSAL SUPPORT AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEYOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-258-3344
Mailing Address - Street 1:650 PENNSYLVANIA AVE SE STE 370
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-4349
Mailing Address - Country:US
Mailing Address - Phone:202-258-3344
Mailing Address - Fax:571-475-9528
Practice Address - Street 1:650 PENNSYLVANIA AVE SE STE 370
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-4349
Practice Address - Country:US
Practice Address - Phone:202-258-3344
Practice Address - Fax:571-475-9528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-03
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities