Provider Demographics
NPI:1528013190
Name:INNOVATIVE SERVICE INC
Entity Type:Organization
Organization Name:INNOVATIVE SERVICE INC
Other - Org Name:UPSTATE HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, CIO
Authorized Official - Prefix:MS
Authorized Official - First Name:ALYCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-531-2800
Mailing Address - Street 1:3890 STATE ROUTE 5 AND 20
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-8101
Mailing Address - Country:US
Mailing Address - Phone:585-394-9200
Mailing Address - Fax:585-394-1485
Practice Address - Street 1:3890 STATE ROUTE 5 AND 20
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-8101
Practice Address - Country:US
Practice Address - Phone:585-394-9200
Practice Address - Fax:585-394-1485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07011004251F00000X, 251J00000X
332B00000X, 332BP3500X, 332BX2000X, 335E00000X
NY0235303336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251F00000XAgenciesHome Infusion
Not Answered251J00000XAgenciesNursing Care
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Not Answered3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01818419Medicaid
NY00895529Medicaid
NY0368430002Medicare NSC