Provider Demographics
NPI:1417703133
Name:INNOVATIVE HOMECARE SERVICES LLC
Entity type:Organization
Organization Name:INNOVATIVE HOMECARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KARNESIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-450-6330
Mailing Address - Street 1:120 19TH ST N STE 201
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35203-3219
Mailing Address - Country:US
Mailing Address - Phone:334-271-9056
Mailing Address - Fax:
Practice Address - Street 1:1565A E TRINITY BLVD STE AA7
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2885
Practice Address - Country:US
Practice Address - Phone:334-751-9056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health