Provider Demographics
NPI:1508339995
Name:INNOVATIVE THERAPEUTIC SERVICES, CORP.
Entity Type:Organization
Organization Name:INNOVATIVE THERAPEUTIC SERVICES, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:CROMARTIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-455-7872
Mailing Address - Street 1:14440 CHERRY LANE CT STE 208
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4946
Mailing Address - Country:US
Mailing Address - Phone:301-604-1458
Mailing Address - Fax:301-604-1459
Practice Address - Street 1:20 W WASHINGTON ST STE 503
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-4817
Practice Address - Country:US
Practice Address - Phone:301-393-3949
Practice Address - Fax:301-745-3482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)