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Organization
INNOVATIVE SERVICES INC
Active
Organization
INNOVATIVE SERVICES INC
Active
Other names
Upstate Homecare
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ALYCE M CROSSMAN (VP, CIO)
(315) 853-1280
Entity
Organization
Contact information
Practice address
435 LAWRENCE BELL DR STE 1B, BUFFALO, NY 14221-8442
(716) 565-2110
Mailing address
PO BOX 325, CLINTON, NY 13323-0325
(315) 853-1280
(315) 853-6087
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
—
—
251J00000X
Nursing Care Agency
0701L005
NY
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02878215
—
NY
01
—
0701L005
DOH LICENSE #
NY
01
—
83Y
MEDICAID ETIN
NY
Enumeration date
10/23/2006
Last updated
09/16/2019
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