Healthcare Provider Details

I. General information

NPI: 1932615895
Provider Name (Legal Business Name): INNOVATIVE SENIOR SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2017
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 W LAMAR ST
AMERICUS GA
31709-3544
US

IV. Provider business mailing address

P.O. BOX 456
AMERICUS GA
31709-3544
US

V. Phone/Fax

Practice location:
  • Phone: 229-380-4719
  • Fax: 229-380-0073
Mailing address:
  • Phone: 866-409-0582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333300000X
TaxonomyEmergency Response System Companies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number129-R-0315
License Number StateGA

VIII. Authorized Official

Name: JESSICA WRIGHT
Title or Position: COO/RN
Credential:
Phone: 866-409-0582