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General NPI Number Information
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NPI Number | 1942935952
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Entity Type | Organization
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Legal Business Name | INNOVATIVE NEONTAL SOLUTIONS LLC
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Dates
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Enumeration Date | 07/22/2022
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Last Update Date | 07/22/2022
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Provider Practice Location Address
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Address Line | 2545 BELLA VISTA DR
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City | SANTA CLARA
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State | UT
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Zip | 84765-1207
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Country | US
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Telephone | 435-817-7619
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Fax | 435-359-5171
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Provider Business Mailing Address
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Address Line | 2545 BELLA VISTA DR
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City | SANTA CLARA
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State | UT
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Zip | 84765-1207
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Country | US
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Telephone | 435-817-7619
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Fax | 435-359-5171
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Authorized Official
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Title or Position | OWNER
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Name | KALLAN C WEBSTER
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Credential |
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Telephone | 435-817-7619
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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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