Provider Demographics
NPI:1366641250
Name:DRK INNOVATIONS
Entity type:Organization
Organization Name:DRK INNOVATIONS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CESAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:608-754-1111
Mailing Address - Street 1:121 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-2929
Mailing Address - Country:US
Mailing Address - Phone:608-754-1111
Mailing Address - Fax:608-754-1111
Practice Address - Street 1:121 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-2929
Practice Address - Country:US
Practice Address - Phone:608-754-1111
Practice Address - Fax:608-754-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health