Provider Demographics
NPI:1326378969
Name:LIVING INNOVATIONS SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:LIVING INNOVATIONS SUPPORT SERVICES, LLC
Other - Org Name:LIVING INNOVATIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:OUELLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-422-7308
Mailing Address - Street 1:273 LOCUST ST UNIT 2C
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-4570
Mailing Address - Country:US
Mailing Address - Phone:603-422-7308
Mailing Address - Fax:
Practice Address - Street 1:273 LOCUST ST UNIT 2C
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-4570
Practice Address - Country:US
Practice Address - Phone:603-422-7308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-04
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME142930000Medicaid
ME143210000Medicaid