Provider Demographics
NPI:1659427722
Name:INNOVATIVE INDUSTRIES INC.
Entity Type:Organization
Organization Name:INNOVATIVE INDUSTRIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROMMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-782-8495
Mailing Address - Street 1:215 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:IA
Mailing Address - Zip Code:50801-2441
Mailing Address - Country:US
Mailing Address - Phone:641-782-8495
Mailing Address - Fax:641-782-6889
Practice Address - Street 1:215 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:CRESTON
Practice Address - State:IA
Practice Address - Zip Code:50801-2441
Practice Address - Country:US
Practice Address - Phone:641-782-8495
Practice Address - Fax:641-782-6889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0230185Medicaid
IA0117192Medicaid