MEDICARE: INNOVATIVE STEPS CO.

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1255678561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVATIVE STEPS CO.

Provider Business Mailing Address
First Line	:	11450 US HIGHWAY 380 STE 130-130
Second Line	:
City	:	CROSSROADS
State	:	TX
Zip	:	76227-8321
Country	:	US
Telephone Number	:	972-821-9503
Fax Number	:	940-440-1301

Provider Business Practice Location Address
First Line	:	2601 LITTLE ELM PKWY STE 1102
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-1921
Country	:	US
Telephone Number	:	972-821-9503
Fax Number	:	940-440-1301

Authorized Official
Title or Position	:	DIRECTOR/CEO
Name	:	BRANDON DEVOR DAVIS
Credential	:
Telephone Number	:	972-821-9503

Provider Enumeration Date	:	01/07/2013
Last Update Date	:	09/23/2023

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Directions to “INNOVATIVE STEPS CO. ” Practice Location

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