Healthcare Provider Details

I. General information

NPI: 1942695895
Provider Name (Legal Business Name): INNOVATIVE CONCEPTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 07/21/2022
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 G ST NW SUITE 500
WASHINGTON DC
20005-3104
US

IV. Provider business mailing address

8639B 16TH ST SUITE D
SILVER SPRING MD
20910-2273
US

V. Phone/Fax

Practice location:
  • Phone: 301-440-7908
  • Fax:
Mailing address:
  • Phone: 301-440-7908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL LAWRENCE SLAUGHTER JR.
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 301-440-7908