Organization
INNOVATIVE SUPPORT SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ADRIANE BERRY JACKSON (EXECUTIVE DIRECTOR)
(704) 856-2293
Entity
Organization
Contact information
Practice address
2730 OLDENWAY DR, CHARLOTTE, NC 28269-9772
(704) 856-2293
(704) 856-2294
Mailing address
PO BOX 560416, CHARLOTTE, NC 28256-0416
(704) 856-2293
(704) 856-2294
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
10/28/2007
Last updated
07/23/2012
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