Provider Demographics
NPI:1578839361
Name:INNOVATIVE SENIOR CARE HOME HEALTH OF RHODE ISLAND LLC
Entity Type:Organization
Organization Name:INNOVATIVE SENIOR CARE HOME HEALTH OF RHODE ISLAND LLC
Other - Org Name:NURSE ON CALL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GACHASSISN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:337-233-1307
Mailing Address - Street 1:PO BOX 51266
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-1266
Mailing Address - Country:US
Mailing Address - Phone:337-233-1304
Mailing Address - Fax:337-443-4154
Practice Address - Street 1:640 GEORGE WASHINGTON HIGHWAY
Practice Address - Street 2:BUILDING C, SUITE 104
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-4244
Practice Address - Country:US
Practice Address - Phone:401-726-7744
Practice Address - Fax:401-726-7774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIHNC02367251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
417059Medicare Oscar/Certification