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General NPI Number Information
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NPI Number | 1265553358
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Entity Type | Organization
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Legal Business Name | INNOVATIVE SUPPORT SERVICES
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8357 TOWNSHIP ROAD 69
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City | KANSAS
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State | OH
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Zip | 44841-9715
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Country | US
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Telephone | 419-986-5560
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Fax | 419-986-5065
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Provider Business Mailing Address
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Address Line | 8357 TOWNSHIP ROAD 69
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City | KANSAS
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State | OH
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Zip | 44841-9715
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Country | US
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Telephone | 419-986-5560
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Fax | 419-986-5065
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Authorized Official
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Title or Position | PRESIDENT
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Name | KENNETH A YOAKUM JR.
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Credential |
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Telephone | 419-986-5560
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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 | 7400253
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License Number State | OH
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