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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
7506 STATE ROUTE 5, CLINTON, NY 13323-3654
(315) 853-1280
(315) 853-6087
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
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02883443
—
NY
01
—
0701L001
DOH LICENSE #
NY
01
—
83Y
MEDICAID ETIN
—
Enumeration date
05/24/2006
Last updated
02/18/2025
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