Healthcare Provider Details

I. General information

NPI: 1720033715
Provider Name (Legal Business Name): INNOVATIVE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7506 STATE ROUTE 5
CLINTON NY
13323-3654
US

IV. Provider business mailing address

PO BOX 325
CLINTON NY
13323-0325
US

V. Phone/Fax

Practice location:
  • Phone: 315-853-1280
  • Fax: 315-853-6087
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 Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 5
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