Provider Demographics
NPI:1962172304
Name:INDIVIDUALIZED SOLUTIONS, LLC
Entity type:Organization
Organization Name:INDIVIDUALIZED SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:DENOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-418-1677
Mailing Address - Street 1:2301 IDLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-2119
Mailing Address - Country:US
Mailing Address - Phone:573-418-1677
Mailing Address - Fax:
Practice Address - Street 1:2301 IDLEWOOD RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-2119
Practice Address - Country:US
Practice Address - Phone:573-418-1677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-16
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health