MEDICARE: INNOVATIONS DEVELOPMENT & GROWTH SERVICES

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	251C00000X	Developmentally Disabled Services Day Training Agency	1817163	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679823561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVATIONS DEVELOPMENT & GROWTH SERVICES

Provider Business Mailing Address
First Line	:	2259 S. TAYLOR RD
Second Line	:
City	:	UNIVERSITY HTS
State	:	OH
Zip	:	44118-3436
Country	:	US
Telephone Number	:	216-832-1004
Fax Number	:

Provider Business Practice Location Address
First Line	:	2259 S. TAYLOR RD
Second Line	:
City	:	UNIVERSITY HTS
State	:	OH
Zip	:	44118-3436
Country	:	US
Telephone Number	:	216-832-1004
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. LATONYA MARIE CUNNINGHAM
Credential	:
Telephone Number	:	216-832-1004

Provider Enumeration Date	:	09/18/2012
Last Update Date	:	09/18/2012

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