Provider Demographics
NPI:1164563342
Name:INNOVATIVE LIVING SOLUTIONS
Entity Type:Organization
Organization Name:INNOVATIVE LIVING SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-838-2662
Mailing Address - Street 1:100 RUE ST FRANCOIS
Mailing Address - Street 2:STE 111
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031
Mailing Address - Country:US
Mailing Address - Phone:314-838-2662
Mailing Address - Fax:314-838-2495
Practice Address - Street 1:100 RUE ST FRANCOIS
Practice Address - Street 2:STE 111
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031
Practice Address - Country:US
Practice Address - Phone:314-838-2662
Practice Address - Fax:314-838-2495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty