Provider Demographics
NPI:1487855409
Name:INNOVATIVE HEALTHCARE SERVICES, INC
Entity Type:Organization
Organization Name:INNOVATIVE HEALTHCARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-321-1052
Mailing Address - Street 1:3622 LYCKAN PKWY
Mailing Address - Street 2:SUITE 6005
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2564
Mailing Address - Country:US
Mailing Address - Phone:919-321-1052
Mailing Address - Fax:919-321-2312
Practice Address - Street 1:3622 LYCKAN PKWY
Practice Address - Street 2:SUITE 6005
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2564
Practice Address - Country:US
Practice Address - Phone:919-321-1052
Practice Address - Fax:919-321-2312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3362251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418104Medicaid