Provider Demographics
NPI:1184215584
Name:INNOVATIVE HEALTHCARE, LLC
Entity Type:Organization
Organization Name:INNOVATIVE HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:META
Authorized Official - Middle Name:H
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, CFNP
Authorized Official - Phone:662-721-6234
Mailing Address - Street 1:17 HILL CIR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-3300
Mailing Address - Country:US
Mailing Address - Phone:662-721-6234
Mailing Address - Fax:
Practice Address - Street 1:17 HILL CIR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-3300
Practice Address - Country:US
Practice Address - Phone:662-721-6234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care