Healthcare Provider Details

I. General information

NPI: 1891096673
Provider Name (Legal Business Name): INNOVATIVE SENIOR CARE HOME HEALTH OF HOLLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NILES RD STE 5
ST JOSEPH MI
49085-3225
US

IV. Provider business mailing address

111 WESTWOOD PL STE 400
BRENTWOOD TN
37027-5021
US

V. Phone/Fax

Practice location:
  • Phone: 269-408-0788
  • Fax:
Mailing address:
  • Phone: 615-221-2250
  • Fax: 615-221-2280

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: DONNIS EVANS
Title or Position: MANAGER, REGULATORY PRACTICES
Credential:
Phone: 615-564-8181