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Organization
INNOVATIVE HEALTH CARE SERVICE OF MIDWEST
Active
Organization
INNOVATIVE HEALTH CARE SERVICE OF MIDWEST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOMINIQUE LAWERENCE (EXECUTIVE DIRECTOR)
(314) 305-0738
Entity
Organization
Contact information
Practice address
4317 176TH ST, COUNTRY CLUB HILLS, IL 60478-4745
(314) 305-0738
(314) 925-2314
Mailing address
4317 176TH ST, COUNTRY CLUB HILLS, IL 60478-4745
(314) 305-0738
(314) 925-2314
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
NULL
Other
Enumeration date
01/14/2022
Last updated
01/14/2022
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