Provider Demographics
NPI:1265239909
Name:INNOVATIVE SUPPORT SOLUTIONS LLC
Entity type:Organization
Organization Name:INNOVATIVE SUPPORT SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOUSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-848-8572
Mailing Address - Street 1:2 WATERFORD WAY UNIT 209
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-8109
Mailing Address - Country:US
Mailing Address - Phone:603-848-8572
Mailing Address - Fax:
Practice Address - Street 1:2 WATERFORD WAY UNIT 209
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-8109
Practice Address - Country:US
Practice Address - Phone:603-848-8572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-28
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities