Provider Demographics
NPI:1629536412
Name:INNOVATED HEALTH CARE LLC
Entity Type:Organization
Organization Name:INNOVATED HEALTH CARE LLC
Other - Org Name:INNOVATED HEALTH CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:AKINLEYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-446-6861
Mailing Address - Street 1:1400 MERCANTILE LN STE 184
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5394
Mailing Address - Country:US
Mailing Address - Phone:301-276-2611
Mailing Address - Fax:301-276-2615
Practice Address - Street 1:1400 MERCANTILE LN STE 184
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-5394
Practice Address - Country:US
Practice Address - Phone:301-777-1555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-11
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility