Provider Demographics
NPI:1407999469
Name:INNOVATIVE HEALTH AT HOME INCORPORATED
Entity Type:Organization
Organization Name:INNOVATIVE HEALTH AT HOME INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:ZAMORA
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:505-883-0665
Mailing Address - Street 1:7801 ACADEMY ROAD NE
Mailing Address - Street 2:BUILDING 2, SUITE 104
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3189
Mailing Address - Country:US
Mailing Address - Phone:505-883-0665
Mailing Address - Fax:505-883-3103
Practice Address - Street 1:7801 ACADEMY ROAD NE
Practice Address - Street 2:BUILDING 2, SUITE 104
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3189
Practice Address - Country:US
Practice Address - Phone:505-883-0665
Practice Address - Fax:505-883-3103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00072335Medicaid
NM000D0553Medicaid