MEDICARE: LEVEL UP SUPPORTIVE 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	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1326991571
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEVEL UP SUPPORTIVE SERVICES, LLC.

Provider Business Mailing Address
First Line	:	4007 W END DR
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23294-5708
Country	:	US
Telephone Number	:	804-714-8360
Fax Number	:

Provider Business Practice Location Address
First Line	:	4609 HILLBROOK AVE
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23231-2109
Country	:	US
Telephone Number	:	804-714-8360
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	KENDALL SMITH
Credential	:	RN
Telephone Number	:	804-714-8360

Provider Enumeration Date	:	02/17/2026
Last Update Date	:	02/17/2026

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