Provider Demographics
NPI:1407612161
Name:LIVING INNOVATIONS SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:LIVING INNOVATIONS SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE & ACCOUNTING
Authorized Official - Prefix:MS
Authorized Official - First Name:KERRIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:603-534-6089
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:603-534-6089
Mailing Address - Fax:
Practice Address - Street 1:15 LUND RD
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-1806
Practice Address - Country:US
Practice Address - Phone:603-534-6089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services