Provider Demographics
NPI:1871647792
Name:INNOVATIVE SOLUTIONS ADDICTION TREATMENT CENTER
Entity Type:Organization
Organization Name:INNOVATIVE SOLUTIONS ADDICTION TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-452-9200
Mailing Address - Street 1:300 S 9TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-3894
Mailing Address - Country:US
Mailing Address - Phone:785-452-9200
Mailing Address - Fax:785-452-9202
Practice Address - Street 1:300 S 9TH ST STE 102
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-3894
Practice Address - Country:US
Practice Address - Phone:785-452-9200
Practice Address - Fax:785-452-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS116079OtherBLUE CROSS BLUE SHIELD