Provider Demographics
NPI:1831625482
Name:INNOVATIVE HOME CARE SERVICES
Entity type:Organization
Organization Name:INNOVATIVE HOME CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KERLLANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:OCCEUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-738-8688
Mailing Address - Street 1:734 ROBIN HOOD DR
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-3985
Mailing Address - Country:US
Mailing Address - Phone:239-738-8688
Mailing Address - Fax:
Practice Address - Street 1:734 ROBIN HOOD DR
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-3985
Practice Address - Country:US
Practice Address - Phone:239-738-8688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care