Provider Demographics
NPI:1528511912
Name:INNOVATIVE TEAM CARE
Entity type:Organization
Organization Name:INNOVATIVE TEAM CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:ADU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-834-3601
Mailing Address - Street 1:14 CARRIAGE CROSSING LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-5827
Mailing Address - Country:US
Mailing Address - Phone:860-834-3601
Mailing Address - Fax:
Practice Address - Street 1:14 CARRIAGE CROSSING LN
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-5827
Practice Address - Country:US
Practice Address - Phone:860-834-3601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care