NPIMap

Organization Active NPI

Innovative Support Services, LLC

  • Developmentally Disabled Services Day Training Agency
  • Charlotte, NC
National Provider Identifier
1790964625
Registry record updated Jul 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X
Legal business name
INNOVATIVE SUPPORT SERVICES, LLC
Practice address
2730 Oldenway Dr
Charlotte, NC 28269-9772
Phone
(704) 856-2293
Fax
(704) 856-2294
NPI assigned
Oct 28, 2007
Last updated
Jul 23, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2012

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

Authorized official

Name
Mrs. Adriane Berry Jackson
Title
Executive Director
Phone
(704) 856-2293

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X NU Primary

Addresses

Primary practice location

2730 Oldenway Dr
Charlotte, NC 28269-9772

Mailing address

PO Box 560416
Charlotte, NC 28256-0416
Phone (704) 856-2293

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1193529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343001600000",
    "number": "1790964625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 560416",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282560416",
            "telephone_number": "704-856-2293",
            "fax_number": "704-856-2294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2730 OLDENWAY DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282699772",
            "telephone_number": "704-856-2293",
            "fax_number": "704-856-2294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE SUPPORT SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-28",
        "last_updated": "2012-07-23",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "ADRIANE",
        "authorized_official_middle_name": "BERRY",
        "authorized_official_title_or_position": "EXECUTIVE  DIRECTOR",
        "authorized_official_telephone_number": "704-856-2293",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2012; 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.