Provider Demographics
NPI:1356509426
Name:INNOVATIVE LIFE SOLUTIONS INC
Entity Type:Organization
Organization Name:INNOVATIVE LIFE SOLUTIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:301-270-4750
Mailing Address - Street 1:6475 NEW HAMPSHIRE AVE
Mailing Address - Street 2:SUITE 760
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3269
Mailing Address - Country:US
Mailing Address - Phone:301-270-4750
Mailing Address - Fax:301-270-4754
Practice Address - Street 1:300 HAMILTON ST NE
Practice Address - Street 2:APT. T05
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-6305
Practice Address - Country:US
Practice Address - Phone:301-270-4750
Practice Address - Fax:301-270-4754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC038730400Medicaid