Provider Demographics
NPI:1003862020
Name:INNOVATIVE SERVICES INC
Entity Type:Organization
Organization Name:INNOVATIVE SERVICES INC
Other - Org Name:UPSTATE HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, CIO
Authorized Official - Prefix:
Authorized Official - First Name:ALYCE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-853-1280
Mailing Address - Street 1:7506 STATE ROUTE 5
Mailing Address - Street 2:PO BOX 325
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-3654
Mailing Address - Country:US
Mailing Address - Phone:315-853-1280
Mailing Address - Fax:315-853-6087
Practice Address - Street 1:6700 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13211-2141
Practice Address - Country:US
Practice Address - Phone:315-437-1627
Practice Address - Fax:315-437-7931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BP3500X, 332BX2000X, 333600000X
NY0235303336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0701L004OtherDOH LIC#
3336650OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY23530OtherPHARM LIC#
NY6853OtherMCD PIN
NY01818419Medicaid
NYTRMOtherMCD ETIN
NYBI5726774OtherDEA#
NY01818419Medicaid