Healthcare Provider Details

I. General information

NPI: 1700145166
Provider Name (Legal Business Name): INNOVATIVE SENIOR CARE HOME HEALTH OF SAN JOSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2012
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5674 STONERIDGE DR STE 210
PLEASANTON CA
94588-8567
US

IV. Provider business mailing address

1 PARK PLZ
NASHVILLE TN
37203-6527
US

V. Phone/Fax

Practice location:
  • Phone: 925-224-8675
  • Fax:
Mailing address:
  • Phone: 615-344-9551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM BRADLEY PARRISH
Title or Position: CFO, HOME HEALTH & HOSPICE
Credential:
Phone: 512-565-8439