MEDICARE: INNOVATIVE CARE SOLUTIONS INC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1902205586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVATIVE CARE SOLUTIONS INC

Provider Business Mailing Address
First Line	:	3797 FILTON DR
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27406-9807
Country	:	US
Telephone Number	:	720-921-6275
Fax Number	:	336-217-8177

Provider Business Practice Location Address
First Line	:	3797 FILTON DR
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27406-9807
Country	:	US
Telephone Number	:	720-921-6275
Fax Number	:	336-217-8177

Authorized Official
Title or Position	:	CEO
Name	:	BRYAN HILL
Credential	:
Telephone Number	:	720-921-6275

Provider Enumeration Date	:	08/19/2014
Last Update Date	:	08/19/2014

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