Healthcare Provider Details

I. General information

NPI: 1588353767
Provider Name (Legal Business Name): UNIVERSAL SUPPORT AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 PENNSYLVANIA AVE SE STE 370
WASHINGTON DC
20003-4349
US

IV. Provider business mailing address

650 PENNSYLVANIA AVE SE STE 370
WASHINGTON DC
20003-4349
US

V. Phone/Fax

Practice location:
  • Phone: 202-258-3344
  • Fax: 571-475-9528
Mailing address:
  • Phone: 202-258-3344
  • Fax: 571-475-9528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ROGER E LEYOU
Title or Position: CEO
Credential:
Phone: 202-258-3344