Provider Demographics
NPI:1942723028
Name:INNOVATIVE HEALTH CARE INSTITUTE LLC
Entity Type:Organization
Organization Name:INNOVATIVE HEALTH CARE INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CSHANYSE
Authorized Official - Middle Name:AVRIL
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, MSN, RN
Authorized Official - Phone:706-705-2033
Mailing Address - Street 1:100 SEAGRAVES DR STE 1
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-2492
Mailing Address - Country:US
Mailing Address - Phone:706-705-2033
Mailing Address - Fax:706-850-8005
Practice Address - Street 1:100 SEAGRAVES DR STE 1
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-2492
Practice Address - Country:US
Practice Address - Phone:706-705-2033
Practice Address - Fax:706-850-8005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-20
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN146812163W00000X
163W00000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty