Provider Demographics
NPI:1275762783
Name:INTRGRATED SUPPORT SOLUTIONS
Entity Type:Organization
Organization Name:INTRGRATED SUPPORT SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEELA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:COUTU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-580-3066
Mailing Address - Street 1:3027 E SUNSET
Mailing Address - Street 2:STE 201
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120
Mailing Address - Country:US
Mailing Address - Phone:702-741-7440
Mailing Address - Fax:
Practice Address - Street 1:3027 E SUNSET
Practice Address - Street 2:STE 201
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120
Practice Address - Country:US
Practice Address - Phone:702-741-7440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-06
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service