Provider Demographics
NPI:1982030227
Name:INNOVATIVE CARE UNLIMITED HEALTH AGENCY, LLC
Entity Type:Organization
Organization Name:INNOVATIVE CARE UNLIMITED HEALTH AGENCY, LLC
Other - Org Name:ICU HEALTH AGENCY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:LAKISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:314-315-7288
Mailing Address - Street 1:11922 CATO DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-6904
Mailing Address - Country:US
Mailing Address - Phone:314-315-7288
Mailing Address - Fax:314-395-7942
Practice Address - Street 1:11922 CATO DRIVE
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033
Practice Address - Country:US
Practice Address - Phone:314-315-7288
Practice Address - Fax:314-395-7942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health