MEDICARE: LIVING INNOVATIONS SUPPORT SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1104750843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVING INNOVATIONS SUPPORT SERVICES, LLC

Provider Business Mailing Address
First Line	:	273 LOCUST ST UNIT 2C
Second Line	:
City	:	DOVER
State	:	NH
Zip	:	03820-4570
Country	:	US
Telephone Number	:	603-422-7208
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 LUND RD STE 101
Second Line	:
City	:	SACO
State	:	ME
Zip	:	04072-1806
Country	:	US
Telephone Number	:	207-282-3311
Fax Number	:

Authorized Official
Title or Position	:	REVENUE CYCLE MANAGER
Name	:	NICOLE MULLINS
Credential	:
Telephone Number	:	603-605-4575

Provider Enumeration Date	:	06/09/2026
Last Update Date	:	06/09/2026

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