Healthcare Provider Details

I. General information

NPI: 1093826596
Provider Name (Legal Business Name): INNOVIVE HEALTH OF MASSACHUSETTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CABOT RD STE 201
MEDFORD MA
02155-5173
US

IV. Provider business mailing address

10 CABOT RD STE 201
MEDFORD MA
02155-5173
US

V. Phone/Fax

Practice location:
  • Phone: 800-915-3211
  • Fax:
Mailing address:
  • Phone: 800-915-3211
  • 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: JOSEPH MCDONOUGH
Title or Position: MEMBER MANAGER
Credential:
Phone: 617-623-3211