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General NPI Number Information
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NPI Number | 1316597354
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Entity Type | Organization
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Legal Business Name | INNOVATIVE CARE SOLUTIONS
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Dates
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Enumeration Date | 09/11/2019
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Last Update Date | 12/08/2020
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Provider Practice Location Address
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Address Line | 2307 W ANDREW JOHNSON HWY STE 113
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City | MORRISTOWN
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State | TN
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Zip | 37814-8500
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Country | US
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Telephone | 423-839-0720
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Fax |
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Provider Business Mailing Address
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Address Line | 2307 W ANDREW JOHNSON HWY STE 113
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City | MORRISTOWN
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State | TN
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Zip | 37814-8500
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Country | US
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Telephone | 423-839-0720
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JERRAMY CANTRELL
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Credential |
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Telephone | 931-761-5732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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