Provider Demographics
NPI:1326213000
Name:INNOVATIVE TREATMENT SERVICES, INC.
Entity Type:Organization
Organization Name:INNOVATIVE TREATMENT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:AA
Authorized Official - Phone:561-790-4177
Mailing Address - Street 1:410 NW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-4129
Mailing Address - Country:US
Mailing Address - Phone:863-467-5335
Mailing Address - Fax:863-467-5366
Practice Address - Street 1:410 NW 3RD STREET
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-4129
Practice Address - Country:US
Practice Address - Phone:863-467-5335
Practice Address - Fax:863-467-5366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW3090251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL600074888Medicaid