Organization
INNOVATIVE HEALTH CARE SERVICE OF MIDWEST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOMINIQUE LAWERENCE (EXECUTIVE DIRECTOR)
(314) 305-0738
Entity
Organization
Contact information
Practice address
4317 176TH ST, COUNTRY CLUB HILLS, IL 60478-4745
(314) 305-0738
(314) 925-2314
Mailing address
4317 176TH ST, COUNTRY CLUB HILLS, IL 60478-4745
(314) 305-0738
(314) 925-2314
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
01/14/2022
Last updated
01/14/2022
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