Provider Demographics
NPI:1699837856
Name:INNOVATIVE CARE, INC.
Entity Type:Organization
Organization Name:INNOVATIVE CARE, INC.
Other - Org Name:B-CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:T.
Authorized Official - Middle Name:RODNEY
Authorized Official - Last Name:WORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-998-7351
Mailing Address - Street 1:PO BOX 1678
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-1678
Mailing Address - Country:US
Mailing Address - Phone:336-998-7351
Mailing Address - Fax:336-998-5470
Practice Address - Street 1:5190 US HIGHWAY 158
Practice Address - Street 2:
Practice Address - City:ADVANCE
Practice Address - State:NC
Practice Address - Zip Code:27006-6946
Practice Address - Country:US
Practice Address - Phone:336-998-7351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4581854Medicaid
NC7701352Medicaid
NC0846660001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER