Provider Demographics
NPI:1306428065
Name:INNOVATIVE CARE NETWORK LLC
Entity type:Organization
Organization Name:INNOVATIVE CARE NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIANNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-279-1509
Mailing Address - Street 1:30190 US HIGHWAY 19 N STE 1013
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-1044
Mailing Address - Country:US
Mailing Address - Phone:121-527-9150
Mailing Address - Fax:
Practice Address - Street 1:3750 WINNERS CIR APT 310
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-4372
Practice Address - Country:US
Practice Address - Phone:215-279-1509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INNOVATIVE CARE NETWORK LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty