Provider Demographics
NPI:1598204745
Name:INNOVATIVE HEARING CARE, LLC
Entity Type:Organization
Organization Name:INNOVATIVE HEARING CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:TEELE
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:951-352-7920
Mailing Address - Street 1:3975 JACKSON ST STE 204
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3948
Mailing Address - Country:US
Mailing Address - Phone:951-977-9121
Mailing Address - Fax:951-977-9317
Practice Address - Street 1:3975 JACKSON ST STE 204
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503
Practice Address - Country:US
Practice Address - Phone:951-977-9121
Practice Address - Fax:951-977-9317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-21
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1083237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty