Provider Demographics
NPI:1942935952
Name:INNOVATIVE NEONTAL SOLUTIONS LLC
Entity Type:Organization
Organization Name:INNOVATIVE NEONTAL SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KALLAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WEBSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-817-7619
Mailing Address - Street 1:2545 BELLA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:UT
Mailing Address - Zip Code:84765-1207
Mailing Address - Country:US
Mailing Address - Phone:435-817-7619
Mailing Address - Fax:435-359-5171
Practice Address - Street 1:2545 BELLA VISTA DR
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:UT
Practice Address - Zip Code:84765-1207
Practice Address - Country:US
Practice Address - Phone:435-817-7619
Practice Address - Fax:435-359-5171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health