Innovative Solutions Personal Care Home

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

INNOVATIVE SOLUTIONS PERSONAL CARE HOME

Doing business as

INNOVATIVE SOLUTIONS PERSONAL CARE HOME

Practice address

569 Phyllis Cir
Camilla, GA 31730-6438

Phone

(229) 462-2055

NPI assigned

Nov 8, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tenesha Denise Givens, LPN

Title

Owner/Administrator

Phone

(229) 462-2055

Specialties & licenses 2

Addresses

Other names 1

• INNOVATIVE SOLUTIONS PERSONAL CARE HOME Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1478563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478563200000",
    "number": "1730621756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "569 PHYLLIS CIR",
            "city": "CAMILLA",
            "state": "GA",
            "postal_code": "317306438",
            "telephone_number": "229-462-2055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "569 PHYLLIS CIR",
            "city": "CAMILLA",
            "state": "GA",
            "postal_code": "317306438",
            "telephone_number": "229-462-2055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE SOLUTIONS PERSONAL CARE HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-08",
        "last_updated": "2016-11-08",
        "status": "A",
        "authorized_official_last_name": "GIVENS",
        "authorized_official_first_name": "TENESHA",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "229-462-2055",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "INNOVATIVE SOLUTIONS PERSONAL CARE HOME",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Camilla, GA
• Providers in Camilla, GA by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.