Provider Demographics
NPI:1679823561
Name:INNOVATIONS DEVELOPMENT & GROWTH SERVICES
Entity Type:Organization
Organization Name:INNOVATIONS DEVELOPMENT & GROWTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LATONYA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-832-1004
Mailing Address - Street 1:2259 S. TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-3436
Mailing Address - Country:US
Mailing Address - Phone:216-832-1004
Mailing Address - Fax:
Practice Address - Street 1:2259 S. TAYLOR RD
Practice Address - Street 2:
Practice Address - City:UNIVERSITY HTS
Practice Address - State:OH
Practice Address - Zip Code:44118-3436
Practice Address - Country:US
Practice Address - Phone:216-832-1004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1817163251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0061797Medicaid