Provider Demographics
NPI:1396347167
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:STACY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-918-5391
Mailing Address - Street 1:1169 NECTAR DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63137-2225
Mailing Address - Country:US
Mailing Address - Phone:314-918-5391
Mailing Address - Fax:314-328-6224
Practice Address - Street 1:1169 NECTAR DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63137-2225
Practice Address - Country:US
Practice Address - Phone:314-918-5391
Practice Address - Fax:314-328-6224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health