Provider Demographics
NPI:1881075463
Name:INNOVATIVE HEALTHCARE DELIVERY, LLV
Entity type:Organization
Organization Name:INNOVATIVE HEALTHCARE DELIVERY, LLV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEUCTIVE VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUYOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-371-6842
Mailing Address - Street 1:3540 W SAHARA AVE # 444
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-5816
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3540 W SAHARA AVE # 444
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-5816
Practice Address - Country:US
Practice Address - Phone:702-534-5537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health