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Organization
INNOVATIVE START LLC
Active
Organization
INNOVATIVE START LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DORIS GREEN (OWNER)
(504) 729-0408
Entity
Organization
Contact information
Practice address
1101 FRANKLIN AVE, GRETNA, LA 70053-2312
(504) 729-0408
(504) 361-5973
Mailing address
1101 FRANKLIN AVE, GRETNA, LA 70053-2312
(504) 729-0408
(504) 361-5973
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
NULL
Other
Enumeration date
07/27/2016
Last updated
07/27/2016
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