Healthcare Provider Details

I. General information

NPI: 1255979233
Provider Name (Legal Business Name): INNOVATIVE CARE PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2019
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9513 BUSINESS CENTER DR, BLDG 8, STE C
RANCHO CUCAMONGA CA
91730-4500
US

IV. Provider business mailing address

9513 BUSINESS CENTER DR, BLDG 8, STE C
RANCHO CUCAMONGA CA
91730-4500
US

V. Phone/Fax

Practice location:
  • Phone: 909-244-0444
  • Fax: 909-244-0170
Mailing address:
  • Phone: 909-244-0444
  • Fax: 909-244-0170

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: MR. JEROME B MENDOZA
Title or Position: CEO
Credential:
Phone: 909-244-0444