MEDICARE: INNOVATIVE HEALTH SPECIALISTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	1416ARAE	OH

General Provider Information

NPI Number	:	1073558698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVATIVE HEALTH SPECIALISTS

Provider Business Mailing Address
First Line	:	16354 EUCLID AVE
Second Line	:
City	:	EAST CLEVELAND
State	:	OH
Zip	:	44112-1637
Country	:	US
Telephone Number	:	216-315-5445
Fax Number	:	126-851-0061

Provider Business Practice Location Address
First Line	:	16354 EUCLID AVE
Second Line	:
City	:	EAST CLEVELAND
State	:	OH
Zip	:	44112-1637
Country	:	US
Telephone Number	:	216-315-5445
Fax Number	:	216-851-0061

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	MS. BETTY JEAN MAHONE I
Credential	:	REGISTER NURSE
Telephone Number	:	216-315-5445

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	10/09/2007

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