# INNOVATIVE HOME HEALTH AGENCY

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

## Provider details

- **NPI number:** 1356114870
- **Authorized official:** KIMBERLY GORDON (OWNER)
- **Authorized official phone:** (980) 287-6420

## Contact information

- **Practice address:** 101 N TRYON ST, CHARLOTTE, NC 28246-0100
- **Practice address phone:** (980) 287-6420
- **Mailing address:** 11719 ALLEN A BROWN RD, CHARLOTTE, NC 28269-8412
- **Mailing address phone:** (980) 287-6420

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WH0200X | Home Health Registered Nurse | — | NULL | Yes |
| 163WH0200X | Home Health Registered Nurse | — | — | Yes |

## Other

- **Enumeration date:** 11/06/2023
- **Last updated:** 11/06/2023