Provider Demographics
NPI:1285360560
Name:INNOVA RECOVERY CENTER, PLLC
Entity type:Organization
Organization Name:INNOVA RECOVERY CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KASI
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:210-838-0090
Mailing Address - Street 1:1842 LOCKHILL SELMA RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1559
Mailing Address - Country:US
Mailing Address - Phone:210-838-0090
Mailing Address - Fax:210-881-9022
Practice Address - Street 1:319 LOS INDIOS RANCH RD
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-5724
Practice Address - Country:US
Practice Address - Phone:210-254-3618
Practice Address - Fax:210-881-9022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children