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Organization

INNOVATIVE SUPPORT SERVICES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KENNETH A YOAKUM JR. (PRESIDENT)
(419) 986-5560
Entity
Organization

Contact information

Practice address
8357 TOWNSHIP ROAD 69, KANSAS, OH 44841-9715
(419) 986-5560
(419) 986-5065
Mailing address
8357 TOWNSHIP ROAD 69, KANSAS, OH 44841-9715
(419) 986-5560
(419) 986-5065

Taxonomy

Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
7400253
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0185491
OH
01
7400253
ODMRDD PROVIDER #
OH
Enumeration date
04/03/2007
Last updated
08/22/2020
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