Provider Demographics
NPI:1679370340
Name:AWESOME INNOVATIVE SERVICES LLC
Entity type:Organization
Organization Name:AWESOME INNOVATIVE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-865-6168
Mailing Address - Street 1:6022 JEFFERSON AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23605-3000
Mailing Address - Country:US
Mailing Address - Phone:718-865-6168
Mailing Address - Fax:
Practice Address - Street 1:6022 JEFFERSON AVE STE 203
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23605-3000
Practice Address - Country:US
Practice Address - Phone:718-865-6168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health