# INNOVATIVE HEALTH CARE SERVICE OF MIDWEST

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225789837
- **Authorized official:** DOMINIQUE LAWERENCE (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (314) 305-0738

## Contact information

- **Practice address:** 4317 176TH ST, COUNTRY CLUB HILLS, IL 60478-4745
- **Practice address phone:** (314) 305-0738
- **Practice address fax:** (314) 925-2314
- **Mailing address:** 4317 176TH ST, COUNTRY CLUB HILLS, IL 60478-4745
- **Mailing address phone:** (314) 305-0738
- **Mailing address fax:** (314) 925-2314

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 01/14/2022
- **Last updated:** 01/14/2022