Healthcare Provider Details

I. General information

NPI: 1316865918
Provider Name (Legal Business Name): INNOVATIVE SENIOR HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 OLD CASSATT RD STE 206
BERWYN PA
19312-1138
US

IV. Provider business mailing address

PO BOX 1911
SOUTHEASTERN PA
19399-1911
US

V. Phone/Fax

Practice location:
  • Phone: 610-773-9943
  • Fax:
Mailing address:
  • Phone: 610-773-9943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. CORTLYND NESBITT
Title or Position: CO OWNER
Credential:
Phone: 610-420-9624