Healthcare Provider Details

I. General information

NPI: 1245666080
Provider Name (Legal Business Name): KALEO SUPPORT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 SCARBOROUGH ST
SPRING LAKE NC
28390-3829
US

IV. Provider business mailing address

3718 GOLFVIEW RD
HOPE MILLS NC
28348-2818
US

V. Phone/Fax

Practice location:
  • Phone: 910-630-2255
  • Fax: 910-339-2808
Mailing address:
  • Phone: 910-322-2755
  • Fax: 910-339-2808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number3418487
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: NANCY SZYMKOWIAK
Title or Position: PRESIDENT
Credential:
Phone: 910-630-2255