Provider Demographics
NPI:1942695895
Name:INNOVATIVE CONCEPTS, INC.
Entity Type:Organization
Organization Name:INNOVATIVE CONCEPTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:SLAUGHTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:301-440-7908
Mailing Address - Street 1:8639B 16TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-2273
Mailing Address - Country:US
Mailing Address - Phone:301-440-7908
Mailing Address - Fax:
Practice Address - Street 1:1325 G ST NW
Practice Address - Street 2:SUITE 500
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-3104
Practice Address - Country:US
Practice Address - Phone:301-440-7908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QD1600X
MD320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness