Healthcare Provider Details

I. General information

NPI: 1073720512
Provider Name (Legal Business Name): INTEGRATED SUPPORT SOLUTIONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14558 SYLVAN ST 1ST FLOOR
VAN NUYS CA
91411-2324
US

IV. Provider business mailing address

14558 SYLVAN ST 1ST FLOOR
VAN NUYS CA
91411-2324
US

V. Phone/Fax

Practice location:
  • Phone: 818-787-2828
  • Fax: 818-787-2840
Mailing address:
  • Phone: 818-787-2828
  • Fax: 818-787-2840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. MARK SHERMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 818-787-2828