Healthcare Provider Details

I. General information

NPI: 1215365291
Provider Name (Legal Business Name): INNOVATION CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 VERMONT AVE NW STE 715
WASHINGTON DC
20005-3544
US

IV. Provider business mailing address

11700 OLD COLUMBIA PIKE APT 2208 2208
SILVER SPRING MD
20904-2559
US

V. Phone/Fax

Practice location:
  • Phone: 301-455-4176
  • Fax:
Mailing address:
  • Phone: 301-455-4176
  • Fax:

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 Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. KIMBERLY LYNETTE RICE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 301-455-4176