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General NPI Number Information
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NPI Number | 1073558698
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Entity Type | Organization
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Legal Business Name | INNOVATIVE HEALTH SPECIALISTS
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 10/09/2007
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Provider Practice Location Address
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Address Line | 16354 EUCLID AVE
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City | EAST CLEVELAND
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State | OH
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Zip | 44112-1637
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Country | US
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Telephone | 216-315-5445
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Fax | 216-851-0061
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Provider Business Mailing Address
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Address Line | 16354 EUCLID AVE
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City | EAST CLEVELAND
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State | OH
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Zip | 44112-1637
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Country | US
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Telephone | 216-315-5445
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Fax | 126-851-0061
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MS. BETTY JEAN MAHONE I
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Credential | REGISTER NURSE
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Telephone | 216-315-5445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1416ARAE
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License Number State | OH
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