Healthcare Provider Details

I. General information

NPI: 1205452794
Provider Name (Legal Business Name): INNOVATIVE HEALTHCARE CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

746 S MAIN AVE STE B
FALLBROOK CA
92028-3352
US

IV. Provider business mailing address

746 S MAIN AVE STE B
FALLBROOK CA
92028-3352
US

V. Phone/Fax

Practice location:
  • Phone: 760-731-1334
  • Fax: 833-790-2628
Mailing address:
  • Phone: 760-731-1334
  • Fax: 833-790-2628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: NITA VIJH-FAUTIER
Title or Position: OWNER AND CEO
Credential:
Phone: 650-804-6268