MEDICARE: INNOVATIVE HEALING LLC

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	175L00000X	Homeopath	20131439273	NV

General Provider Information

NPI Number	:	1184052417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVATIVE HEALING LLC

Provider Business Mailing Address
First Line	:	7045 W ANN RD
Second Line	:	SUITE 130
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3864
Country	:	US
Telephone Number	:	702-463-4400
Fax Number	:	702-463-4401

Provider Business Practice Location Address
First Line	:	7045 W ANN RD
Second Line	:	SUITE 130
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3864
Country	:	US
Telephone Number	:	702-463-4400
Fax Number	:	702-463-4401

Authorized Official
Title or Position	:	OWNER
Name	:	ELIZABETH BELCHER
Credential	:
Telephone Number	:	702-463-4400

Provider Enumeration Date	:	10/23/2013
Last Update Date	:	01/28/2014

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