Organization
INNOVATIVE WISCONSIN, LLC
Active
Parent organization
INNOVATIVE SERVICES, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
INNOVATIVE SERVICES, INC.
Authorized official
DRUE RAY (OFFICER)
(828) 684-8441
Entity
Organization
Contact information
Practice address
445 S MADISON ST, GREEN BAY, WI 54301-4101
(920) 431-0962
(920) 884-1967
Mailing address
445 S MADISON ST, GREEN BAY, WI 54301-4101
(920) 431-0962
(920) 884-1967
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
WI
Other
Enumeration date
05/29/2015
Last updated
05/29/2015
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