Healthcare Provider Details

I. General information

NPI: 1073633376
Provider Name (Legal Business Name): LIVING INNOVATIONS SUPPORT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 03/25/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 603-422-7308
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. NEAL OUELLETT
Title or Position: PRESIDENT
Credential:
Phone: 603-422-7308