Healthcare Provider Details

I. General information

NPI: 1003094350
Provider Name (Legal Business Name): INNOVATIVE HOME CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35325 DATE PALM DR STE 150
CATHEDRAL CITY CA
92234-7014
US

IV. Provider business mailing address

35325 DATE PALM DR STE 253
CATHEDRAL CITY CA
92234-7014
US

V. Phone/Fax

Practice location:
  • Phone: 760-321-2945
  • Fax: 760-770-3506
Mailing address:
  • Phone: 760-321-2945
  • Fax: 760-770-3506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. LISA MARIE BLASKIE
Title or Position: PRESIDENT
Credential: RN, CCM
Phone: 760-321-2945