Provider Demographics
NPI:1184917106
Name:INNOVATIVE HOME CARE INC
Entity type:Organization
Organization Name:INNOVATIVE HOME CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLASKIE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CCM, CSA
Authorized Official - Phone:760-898-0000
Mailing Address - Street 1:655 MONTGOMERY ST
Mailing Address - Street 2:STE 540
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-2635
Mailing Address - Country:US
Mailing Address - Phone:415-264-4430
Mailing Address - Fax:415-837-3204
Practice Address - Street 1:655 MONTGOMERY ST
Practice Address - Street 2:STE 540
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-2635
Practice Address - Country:US
Practice Address - Phone:415-264-4430
Practice Address - Fax:415-837-3204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care