Provider Demographics
NPI:1083328306
Name:INNOVIVE HEALTH OF COLORADO LLC
Entity Type:Organization
Organization Name:INNOVIVE HEALTH OF COLORADO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUMIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-915-3211
Mailing Address - Street 1:10 CABOT RD STE 201
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-5173
Mailing Address - Country:US
Mailing Address - Phone:800-915-3211
Mailing Address - Fax:
Practice Address - Street 1:6165 LEHMAN DR STE 102
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-5405
Practice Address - Country:US
Practice Address - Phone:800-915-3211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health