Healthcare Provider Details

I. General information

NPI: 1952754657
Provider Name (Legal Business Name): INNOVATIVE HOME HEALTH GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2016
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19924 HIGHWAY 182
BUNKIE LA
71322-4958
US

IV. Provider business mailing address

10615 JEFFERSON HWY
BATON ROUGE LA
70809-7230
US

V. Phone/Fax

Practice location:
  • Phone: 318-838-2178
  • Fax:
Mailing address:
  • Phone: 225-368-3181
  • 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: PATRICK MITCHELL
Title or Position: MANAGER
Credential:
Phone: 225-368-3181