Provider Demographics
NPI:1902004476
Name:INNOVATIVE LIVING INC.
Entity Type:Organization
Organization Name:INNOVATIVE LIVING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WOLANYO
Authorized Official - Middle Name:K
Authorized Official - Last Name:AGUDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-280-0610
Mailing Address - Street 1:585 EXTON CMNS
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2453
Mailing Address - Country:US
Mailing Address - Phone:610-280-0610
Mailing Address - Fax:610-280-0618
Practice Address - Street 1:585 EXTON CMNS
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2453
Practice Address - Country:US
Practice Address - Phone:610-280-0610
Practice Address - Fax:610-280-0618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health