Provider Demographics
NPI:1902197999
Name:INNOVATIVE HOME HEALTH PRACTICE LLC
Entity Type:Organization
Organization Name:INNOVATIVE HOME HEALTH PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESAH
Authorized Official - Middle Name:
Authorized Official - Last Name:AMPONSAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-914-8330
Mailing Address - Street 1:1415 S HAMILTON RD STE B2
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-1343
Mailing Address - Country:US
Mailing Address - Phone:614-914-8330
Mailing Address - Fax:614-914-8335
Practice Address - Street 1:1415 S HAMILTON RD STE B2
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-1343
Practice Address - Country:US
Practice Address - Phone:614-914-8330
Practice Address - Fax:614-914-8335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health