Provider Demographics
NPI:1790327666
Name:INNOVATION HEALTHCARE SOLUTION, PLLC
Entity Type:Organization
Organization Name:INNOVATION HEALTHCARE SOLUTION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:PROF
Authorized Official - First Name:KATETIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:336-986-3046
Mailing Address - Street 1:3837 CRUSADE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-2252
Mailing Address - Country:US
Mailing Address - Phone:336-986-3046
Mailing Address - Fax:877-445-5698
Practice Address - Street 1:3500 VEST MILL RD STE 33
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2978
Practice Address - Country:US
Practice Address - Phone:336-934-5354
Practice Address - Fax:877-445-5698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251J00000XAgenciesNursing CareGroup - Multi-Specialty
No251F00000XAgenciesHome Infusion
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care