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General NPI Number Information
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NPI Number | 1356651533
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Entity Type | Organization
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Legal Business Name | INNOVATION LIFE CARE, LLC
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Dates
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Enumeration Date | 10/20/2010
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Last Update Date | 10/20/2010
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Provider Practice Location Address
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Address Line | 561 N MAIN ST
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City | PITTSTON
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State | PA
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Zip | 18640-2203
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Country | US
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Telephone | 570-602-1560
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Fax | 570-602-1569
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Provider Business Mailing Address
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Address Line | 561 N MAIN ST
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City | PITTSTON
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State | PA
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Zip | 18640-2203
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Country | US
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Telephone | 570-602-1560
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Fax | 570-602-1569
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. TARA SCARANTINO
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Credential |
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Telephone | 570-362-8725
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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 | 20053601
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License Number State | PA
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