Provider Demographics
NPI:1104317155
Name:INNOVATIVE CARE PARTNERS, LLC
Entity type:Organization
Organization Name:INNOVATIVE CARE PARTNERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:AMALE
Authorized Official - Middle Name:B
Authorized Official - Last Name:NEARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-439-2250
Mailing Address - Street 1:332 BIRNIE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1104
Mailing Address - Country:US
Mailing Address - Phone:413-439-2250
Mailing Address - Fax:
Practice Address - Street 1:332 BIRNIE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1104
Practice Address - Country:US
Practice Address - Phone:413-439-2250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INNOVATIVE CARE PARTNERS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management