Provider Demographics
NPI:1699401372
Name:INNOVATE HEALTH SOLUTIONS, LLC
Entity Type:Organization
Organization Name:INNOVATE HEALTH SOLUTIONS, LLC
Other - Org Name:INNOVATIVE HEALTH SOLUTIONS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLANOS
Authorized Official - Suffix:
Authorized Official - Credentials:RESEARCH
Authorized Official - Phone:401-414-1400
Mailing Address - Street 1:2 RICHMOND SQ STE 110
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5135
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 RICHMOND SQ STE 110
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5135
Practice Address - Country:US
Practice Address - Phone:774-432-0446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-26
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty