Provider Demographics
NPI:1336411388
Name:INNOVATIVE CARE, LLC
Entity Type:Organization
Organization Name:INNOVATIVE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASLAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-698-3297
Mailing Address - Street 1:2775 BUFFALO RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-1372
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2775 BUFFALO RD
Practice Address - Street 2:SUITE 2
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-1372
Practice Address - Country:US
Practice Address - Phone:585-235-0560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1677L0013747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty