Provider Demographics
NPI:1811225105
Name:INNOVATIVE HEALTH CARE RESOURCES INC
Entity Type:Organization
Organization Name:INNOVATIVE HEALTH CARE RESOURCES INC
Other - Org Name:IHCR, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:OSWALD
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-878-5631
Mailing Address - Street 1:120 W COLE BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231-9700
Mailing Address - Country:US
Mailing Address - Phone:760-357-7700
Mailing Address - Fax:760-357-7709
Practice Address - Street 1:120 W COLE BLVD
Practice Address - Street 2:STE A
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-9700
Practice Address - Country:US
Practice Address - Phone:760-357-7700
Practice Address - Fax:760-357-7709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG23714Medicare PIN