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General NPI Number Information
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NPI Number | 1295341642
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Entity Type | Organization
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Legal Business Name | INNOVATIVE QUALITY HEALTHCARE SERVICES LLC
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Dates
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Enumeration Date | 09/21/2020
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Last Update Date | 09/21/2020
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Provider Practice Location Address
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Address Line | 3545 BEAVER SWAMP RD
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City | LOGANVILLE
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State | GA
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Zip | 30052-2859
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Country | US
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Telephone | 404-327-1821
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 466483
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City | LAWRENCEVILLE
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State | GA
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Zip | 30042-6483
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Country | US
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Telephone | 404-327-1821
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KIM L STEELE
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Credential |
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Telephone | 404-327-1821
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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 |
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License Number State |
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