Provider Demographics
NPI:1780211789
Name:INNOVATIVE SERVICE INC
Entity Type:Organization
Organization Name:INNOVATIVE SERVICE INC
Other - Org Name:UPSTATE HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CIO
Authorized Official - Prefix:
Authorized Official - First Name:ALYCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-853-1280
Mailing Address - Street 1:7506 STATE ROUTE 5
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-3654
Mailing Address - Country:US
Mailing Address - Phone:315-853-1280
Mailing Address - Fax:315-853-6087
Practice Address - Street 1:25 POST RD
Practice Address - Street 2:
Practice Address - City:COLONIE
Practice Address - State:NY
Practice Address - Zip Code:12205-4781
Practice Address - Country:US
Practice Address - Phone:518-801-0510
Practice Address - Fax:518-375-2709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-27
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0701L006OtherNYS DEPARTMENT OF HEALTH NUMBER