Provider Demographics
NPI:1316481138
Name:INNOVA RECOVERY SERVICES, LLC
Entity type:Organization
Organization Name:INNOVA RECOVERY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-445-9330
Mailing Address - Street 1:1824 WOODMOOR DR
Mailing Address - Street 2:STE 101
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-9097
Mailing Address - Country:US
Mailing Address - Phone:719-445-9330
Mailing Address - Fax:
Practice Address - Street 1:1824 WOODMOOR DR
Practice Address - Street 2:STE 101
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9097
Practice Address - Country:US
Practice Address - Phone:719-445-9330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INNOVA MANAGEMENT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder