Provider Demographics
NPI:1003885799
Name:INNOVATIVE HEALTH SERVICES
Entity Type:Organization
Organization Name:INNOVATIVE HEALTH SERVICES
Other - Org Name:A SPECIAL TOUCH BOUTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRUE
Authorized Official - Middle Name:F
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-754-6315
Mailing Address - Street 1:8252 DARROW ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-2392
Mailing Address - Country:US
Mailing Address - Phone:330-405-9533
Mailing Address - Fax:330-405-9539
Practice Address - Street 1:8252 DARROW ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2392
Practice Address - Country:US
Practice Address - Phone:330-405-9533
Practice Address - Fax:330-405-9539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0983351Medicaid
0836680001Medicare NSC