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General NPI Number Information
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NPI Number | 1467843714
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Entity Type | Organization
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Legal Business Name | INNOVATIVE LIFE SOLUTIONS. INC.
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Dates
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Enumeration Date | 02/09/2015
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Last Update Date | 02/09/2015
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Provider Practice Location Address
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Address Line | 4954 ASTOR PL SE
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City | WASHINGTON
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State | DC
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Zip | 20019-6251
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Country | US
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Telephone | 301-270-4750
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Fax | 301-270-4754
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Provider Business Mailing Address
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Address Line | 6475 NEW HAMPSHIRE AVE SUITE 760
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City | HYATTSVILLE
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State | MD
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Zip | 20783-3269
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Country | US
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Telephone | 301-270-4750
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Fax | 301-270-4754
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. DAVID A. CARRINGTON
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Credential | MBA
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Telephone | 301-270-4750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State | DC
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