Healthcare Provider Details

I. General information

NPI: 1467843714
Provider Name (Legal Business Name): INNOVATIVE LIFE SOLUTIONS. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2015
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4954 ASTOR PL SE
WASHINGTON DC
20019-6251
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 Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateDC

VIII. Authorized Official

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