Provider Demographics
NPI:1912130592
Name:HEALTHY INNOVATIONS
Entity Type:Organization
Organization Name:HEALTHY INNOVATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:PATRICE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:313-952-3328
Mailing Address - Street 1:17250 W 12 MILE RD
Mailing Address - Street 2:SUITE 117
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2127
Mailing Address - Country:US
Mailing Address - Phone:313-952-3328
Mailing Address - Fax:
Practice Address - Street 1:17250 W 12 MILE RD
Practice Address - Street 2:SUITE 117
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2127
Practice Address - Country:US
Practice Address - Phone:313-952-3328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherEIN