Provider Demographics
NPI:1891752879
Name:INNOVATIVE COMMUNITY SOLUTIONS, INC.
Entity Type:Organization
Organization Name:INNOVATIVE COMMUNITY SOLUTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:540-293-2449
Mailing Address - Street 1:799 UNION ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-5122
Mailing Address - Country:US
Mailing Address - Phone:540-293-2449
Mailing Address - Fax:
Practice Address - Street 1:799 UNION ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-5122
Practice Address - Country:US
Practice Address - Phone:540-293-2449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA759-02008251C00000X
VA759320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010134242Medicaid