Provider Demographics
NPI:1083088819
Name:INNOVATIVE HOMECARE, LLC.
Entity Type:Organization
Organization Name:INNOVATIVE HOMECARE, LLC.
Other - Org Name:INNOVATIVE HOMECARE, LLC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LULA
Authorized Official - Middle Name:M
Authorized Official - Last Name:NOLDEN-HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-434-1700
Mailing Address - Street 1:1209 KELLOGG DR
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-4944
Mailing Address - Country:US
Mailing Address - Phone:352-434-1700
Mailing Address - Fax:352-508-9798
Practice Address - Street 1:1209 KELLOGG DR
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4944
Practice Address - Country:US
Practice Address - Phone:352-434-1700
Practice Address - Fax:352-508-9798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-17
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL233478251E00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL352549834Medicaid