Provider Demographics
NPI:1295341642
Name:INNOVATIVE QUALITY HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:INNOVATIVE QUALITY HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:L
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-327-1821
Mailing Address - Street 1:PO BOX 466483
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30042-6483
Mailing Address - Country:US
Mailing Address - Phone:404-327-1821
Mailing Address - Fax:
Practice Address - Street 1:3545 BEAVER SWAMP RD
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-2859
Practice Address - Country:US
Practice Address - Phone:404-327-1821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health