Provider Demographics
NPI:1841449741
Name:INNOVATIVE SUPPORT SERVICES, LTD
Entity type:Organization
Organization Name:INNOVATIVE SUPPORT SERVICES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEMINGWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-618-5282
Mailing Address - Street 1:143 MELMORE ST
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-3045
Mailing Address - Country:US
Mailing Address - Phone:419-618-5282
Mailing Address - Fax:419-986-5065
Practice Address - Street 1:143 MELMORE ST
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-3045
Practice Address - Country:US
Practice Address - Phone:419-618-5282
Practice Address - Fax:419-986-5065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services