Innovative Collaboration Support Services, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

251S00000X Issued in NV

Legal business name

INNOVATIVE COLLABORATION SUPPORT SERVICES, LLC

Practice address

4400 S Jones Blvd Unit 1055
Las Vegas, NV 89103-3339

Phone

(702) 476-9405

NPI assigned

Sep 3, 2010

Organization subpart

No

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

Authorized official

Name

Mr. Michael Donnell Bridges, MA

Title

Clinical Director

Phone

(702) 476-9405

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1283472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283472000000",
    "number": "1841507449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4400 S JONES BLVD UNIT 1055",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891033339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 S JONES BLVD UNIT 1055",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891033339",
            "telephone_number": "702-476-9405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE COLLABORATION SUPPORT SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-03",
        "last_updated": "2010-09-03",
        "status": "A",
        "authorized_official_last_name": "BRIDGES",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "DONNELL",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "702-476-9405",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NV",
            "license": "251S00000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Innovative Healing LLC
• Innovative Healthcare Delivery, LLV
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• Innovative Mentoring and Family Services
• Innovative Mt LLC

• Community/Behavioral Health Agency in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Community/Behavioral Health Agency in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2010; 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.