MEDICARE: EQUALLY ABLE SUPPORT SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1215896691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EQUALLY ABLE SUPPORT SERVICES LLC

Provider Business Mailing Address
First Line	:	1248 CARMIA WAY # 1109
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-4750
Country	:	US
Telephone Number	:	804-295-8711
Fax Number	:	804-545-5471

Provider Business Practice Location Address
First Line	:	715 TWINRIDGE LN
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-5270
Country	:	US
Telephone Number	:	804-295-8711
Fax Number	:	804-545-5471

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. LEAH ANN MCINTOSH
Credential	:
Telephone Number	:	804-306-5842

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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