# INNOVATIVE HEALTH AT HOME

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

## Provider details

- **NPI number:** 1831729086
- **Authorized official:** KIMBERLY JOAN VAZQUEZ (MEDICAL SERVICES ADMINISTRATOR)
- **Authorized official phone:** (231) 733-3525

## Contact information

- **Practice address:** 560 SEMINOLE RD, NORTON SHORES, MI 49444-3720
- **Practice address phone:** (231) 733-3525
- **Mailing address:** 560 SEMINOLE RD, NORTON SHORES, MI 49444-3720

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LG0600X | Gerontology Nurse Practitioner | — | NULL | Yes |
| 363LG0600X | Gerontology Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 01/16/2020
- **Last updated:** 11/13/2024