Provider Demographics
NPI:1851648869
Name:INNOVATIONS HEALTH STAFFING, LLC
Entity Type:Organization
Organization Name:INNOVATIONS HEALTH STAFFING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STRATEGY & IMPLEMENTATION OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:NICCUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-425-1171
Mailing Address - Street 1:1220 MELODY LN STE 155
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-5210
Mailing Address - Country:US
Mailing Address - Phone:916-425-1171
Mailing Address - Fax:916-742-5157
Practice Address - Street 1:1220 MELODY LN STE 155
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-5210
Practice Address - Country:US
Practice Address - Phone:916-425-1171
Practice Address - Fax:916-742-5157
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INNOVATIONS HEALTH SYSTEMS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care