# INNOVATIVE MIND SERVICES

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

## Provider details

- **NPI number:** 1336876341
- **Authorized official:** ADEBUKOLA REBECCA ADEBAYO (CEO)
- **Authorized official phone:** (862) 300-9408

## Contact information

- **Practice address:** 27 MYRTLE AVE APT 2, IRVINGTON, NJ 07111-3319
- **Practice address phone:** (862) 300-9408
- **Mailing address:** 27 MYRTLE AVE APT 2, IRVINGTON, NJ 07111-3319
- **Mailing address phone:** (862) 300-9408

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 385H00000X | Respite Care | — | NULL | Yes |
| 385HR2060X | Child Intellectual and/or Developmental Disabilities Respite Care | — | NULL | — |

## Other

- **Enumeration date:** 08/01/2022
- **Last updated:** 08/01/2022