Healthcare Provider Details

I. General information

NPI: 1659057263
Provider Name (Legal Business Name): INNOVATIVE PERSONAL SUPPORTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4760 NW 44TH TER
OCALA FL
34482-7840
US

IV. Provider business mailing address

67 LOCUST PASS RUN
OCALA FL
34472-6617
US

V. Phone/Fax

Practice location:
  • Phone: 352-484-5236
  • Fax:
Mailing address:
  • Phone: 352-484-5236
  • Fax: 352-687-0199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: SARAH YVETTE MOZELL
Title or Position: PROVIDER/OWNER
Credential:
Phone: 352-484-5236