Provider Demographics
NPI:1689202012
Name:INNOVATIVE CARE LLC
Entity Type:Organization
Organization Name:INNOVATIVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:AUTUMN
Authorized Official - Middle Name:BENSON
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-608-9704
Mailing Address - Street 1:INNOVATIVE CARE LLC
Mailing Address - Street 2:5712 OAK KNOLL RD.
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2400
Mailing Address - Country:US
Mailing Address - Phone:804-608-9704
Mailing Address - Fax:855-700-5593
Practice Address - Street 1:INNOVATIVE CARE LLC
Practice Address - Street 2:5712 OAK KNOLL RD.
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2400
Practice Address - Country:US
Practice Address - Phone:804-608-6577
Practice Address - Fax:855-700-5593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-31
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA601450523Medicaid