Provider Demographics
NPI:1750968566
Name:INNOVATIVE SENIOR SOLUTIONS, LLC
Entity type:Organization
Organization Name:INNOVATIVE SENIOR SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-861-4632
Mailing Address - Street 1:8321 LINE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-5923
Mailing Address - Country:US
Mailing Address - Phone:318-861-4632
Mailing Address - Fax:318-861-0851
Practice Address - Street 1:8321 LINE AVE STE 200
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-5923
Practice Address - Country:US
Practice Address - Phone:318-861-4632
Practice Address - Fax:318-861-0851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care