Provider Demographics
NPI:1003094350
Name:INNOVATIVE HOME CARE INC
Entity Type:Organization
Organization Name:INNOVATIVE HOME CARE INC
Other - Org Name:COMFORCARE SENIOR SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLASKIE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CCM
Authorized Official - Phone:760-321-2945
Mailing Address - Street 1:35325 DATE PALM DR
Mailing Address - Street 2:STE 253
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-7014
Mailing Address - Country:US
Mailing Address - Phone:760-321-2945
Mailing Address - Fax:760-770-3506
Practice Address - Street 1:35325 DATE PALM DR
Practice Address - Street 2:STE 150
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-7014
Practice Address - Country:US
Practice Address - Phone:760-321-2945
Practice Address - Fax:760-770-3506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA007804OtherANTHEM BLUE CROSS