MEDICARE: INNOVATE HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1053080978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVATE HEALTH LLC

Provider Business Mailing Address
First Line	:	10607 WAGNER ST
Second Line	:
City	:	IOWA COLONY
State	:	TX
Zip	:	77583-1339
Country	:	US
Telephone Number	:	347-638-9838
Fax Number	:

Provider Business Practice Location Address
First Line	:	10607 WAGNER ST
Second Line	:
City	:	IOWA COLONY
State	:	TX
Zip	:	77583-1339
Country	:	US
Telephone Number	:	347-638-9838
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	UGOCHUKWU IDEGWU
Credential	:
Telephone Number	:	347-638-9838

Provider Enumeration Date	:	09/13/2021
Last Update Date	:	09/13/2021

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Directions to “INNOVATE HEALTH LLC ” Practice Location

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