Healthcare Provider Details

I. General information

NPI: 1326121369
Provider Name (Legal Business Name): INNOVATIVE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 LAWRENCE BELL DR STE 1B
BUFFALO NY
14221-8442
US

IV. Provider business mailing address

PO BOX 325
CLINTON NY
13323-0325
US

V. Phone/Fax

Practice location:
  • Phone: 716-565-2110
  • Fax:
Mailing address:
  • Phone: 315-853-1280
  • Fax: 315-853-6087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number0701L005
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MS. ALYCE M CROSSMAN
Title or Position: VP, CIO
Credential:
Phone: 315-853-1280