Provider Demographics
NPI:1932615895
Name:INNOVATIVE SENIOR SOLUTIONS, LLC
Entity Type:Organization
Organization Name:INNOVATIVE SENIOR SOLUTIONS, LLC
Other - Org Name:INNOVATIVE SENIOR SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO/RN
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-380-4719
Mailing Address - Street 1:P.O. BOX 456
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3544
Mailing Address - Country:US
Mailing Address - Phone:229-380-4719
Mailing Address - Fax:
Practice Address - Street 1:231 W LAMAR ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3544
Practice Address - Country:US
Practice Address - Phone:229-380-4719
Practice Address - Fax:229-380-0073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-14
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA129-R-0315251J00000X
261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA526289790Medicaid