Provider Demographics
NPI:1659057263
Name:INNOVATIVE PERSONAL SUPPORTS INC
Entity Type:Organization
Organization Name:INNOVATIVE PERSONAL SUPPORTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:MOZELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-484-5236
Mailing Address - Street 1:67 LOCUST PASS RUN
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34472-6617
Mailing Address - Country:US
Mailing Address - Phone:352-484-5236
Mailing Address - Fax:352-687-0199
Practice Address - Street 1:4760 NW 44TH TER
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34482-7840
Practice Address - Country:US
Practice Address - Phone:352-484-5236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle