Healthcare Provider Details

I. General information

NPI: 1275914095
Provider Name (Legal Business Name): INNOVATIVE LIFE SOLUTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3043 BLADENSBURG RD NE
WASHINGTON DC
20018-2233
US

IV. Provider business mailing address

6475 NEW HAMPSHIRE AVE SUITE 760
HYATTSVILLE MD
20783-3269
US

V. Phone/Fax

Practice location:
  • Phone: 301-270-4750
  • Fax: 301-270-4754
Mailing address:
  • Phone: 301-270-4750
  • Fax: 301-270-4754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License NumberTBA
License Number StateDC

VIII. Authorized Official

Name: MR. DAVID A. CARRINGTON
Title or Position: PRESIDENT /CEO
Credential:
Phone: 301-270-4750