Provider Demographics
NPI:1255841300
Name:INNOVATIVE HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:INNOVATIVE HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LENA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAROSELLI
Authorized Official - Suffix:
Authorized Official - Credentials:REEG T
Authorized Official - Phone:610-324-0454
Mailing Address - Street 1:2 STABLE CT
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-4410
Mailing Address - Country:US
Mailing Address - Phone:610-324-0454
Mailing Address - Fax:484-902-0445
Practice Address - Street 1:2 STABLE CT
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-4410
Practice Address - Country:US
Practice Address - Phone:610-324-0454
Practice Address - Fax:484-902-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEGGroup - Single Specialty