Healthcare Provider Details

I. General information

NPI: 1184596702
Provider Name (Legal Business Name): INNOVATIVE MIND SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 HIGH MEADOWS DR
SICKLERVILLE NJ
08081-1981
US

IV. Provider business mailing address

63 HIGH MEADOWS DR
SICKLERVILLE NJ
08081-1981
US

V. Phone/Fax

Practice location:
  • Phone: 862-300-9408
  • Fax:
Mailing address:
  • Phone: 862-300-9408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ADEBUKOLA REBECCA ADEBAYO
Title or Position: CEO
Credential:
Phone: 862-300-9408