Provider Demographics
NPI:1972120152
Name:ENGAGE SUPPORT SERVICES, LLC
Entity type:Organization
Organization Name:ENGAGE SUPPORT SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NICO
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-489-5910
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 1:3306 CLAYS MILL RD STE 207
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3483
Practice Address - Country:US
Practice Address - Phone:859-036-1983
Practice Address - Fax:859-303-6199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-03
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services