Healthcare Provider Details

I. General information

NPI: 1104750843
Provider Name (Legal Business Name): LIVING INNOVATIONS SUPPORT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 LUND RD STE 101
SACO ME
04072-1806
US

IV. Provider business mailing address

273 LOCUST ST UNIT 2C
DOVER NH
03820-4570
US

V. Phone/Fax

Practice location:
  • Phone: 207-282-3311
  • Fax:
Mailing address:
  • Phone: 603-422-7208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: NICOLE MULLINS
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 603-605-4575