Healthcare Provider Details

I. General information

NPI: 1366536187
Provider Name (Legal Business Name): INNOVATIVE HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 SOUTH MAIN STREET
ANAHUAC TX
77514-1470
US

IV. Provider business mailing address

203 SOUTH MAIN STREET PO BOX 1470
ANAHUAC TX
77514-1470
US

V. Phone/Fax

Practice location:
  • Phone: 409-267-6194
  • Fax: 409-267-6428
Mailing address:
  • Phone: 409-267-6194
  • Fax: 409-267-6428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number677914
License Number StateTX

VIII. Authorized Official

Name: MRS. ADELFA YAP ANDRES
Title or Position: ADMINISTRATOR
Credential:
Phone: 409-267-6194