Provider Demographics
NPI:1073558698
Name:INNOVATIVE HEALTH SPECIALISTS
Entity Type:Organization
Organization Name:INNOVATIVE HEALTH SPECIALISTS
Other - Org Name:INNOVATIVE HEALTH SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MAHONE
Authorized Official - Suffix:I
Authorized Official - Credentials:REGISTER NURSE
Authorized Official - Phone:216-315-5445
Mailing Address - Street 1:16354 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:EAST CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-1637
Mailing Address - Country:US
Mailing Address - Phone:216-315-5445
Mailing Address - Fax:126-851-0061
Practice Address - Street 1:16354 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:EAST CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-1637
Practice Address - Country:US
Practice Address - Phone:216-315-5445
Practice Address - Fax:216-851-0061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1416ARAE251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1416ARAEMedicare ID - Type UnspecifiedHOME HEALTH CARE SERVICE