Provider Demographics
NPI:1679359657
Name:INNOVATIONS THERAPEUTIC SERVICES OF KENTUCKY, LLC
Entity type:Organization
Organization Name:INNOVATIONS THERAPEUTIC SERVICES OF KENTUCKY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:B
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:COTA/L
Authorized Official - Phone:502-235-0604
Mailing Address - Street 1:2112 MEADOWS EDGE LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-4734
Mailing Address - Country:US
Mailing Address - Phone:502-235-0604
Mailing Address - Fax:
Practice Address - Street 1:2112 MEADOWS EDGE LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-4734
Practice Address - Country:US
Practice Address - Phone:502-235-0604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-05
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No385H00000XRespite Care FacilityRespite Care