Provider Demographics
NPI:1427180488
Name:INNOVATIVE RESOURCE GROUP, LLC
Entity Type:Organization
Organization Name:INNOVATIVE RESOURCE GROUP, LLC
Other - Org Name:APS HEALTHCARE, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE SECRETARY/GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:TICHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-288-4795
Mailing Address - Street 1:44 SOUTH BORADWAY
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601
Mailing Address - Country:US
Mailing Address - Phone:800-305-3720
Mailing Address - Fax:914-288-4605
Practice Address - Street 1:1680 PHOENIX BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-5576
Practice Address - Country:US
Practice Address - Phone:800-305-3720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APS HEALTHCARE BETHESDA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-12
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA512561725AMedicaid