Healthcare Provider Details

I. General information

NPI: 1619777984
Provider Name (Legal Business Name): INNOVACARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24402 STATE ROAD 54 STE 1914
LUTZ FL
33559-7303
US

IV. Provider business mailing address

32135 POND APPLE BND
SAN ANTONIO FL
33576-7380
US

V. Phone/Fax

Practice location:
  • Phone: 727-505-0913
  • Fax:
Mailing address:
  • Phone: 727-505-0913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SORAYA DEL VALLE MARCANO CASTILLO
Title or Position: OWNER
Credential:
Phone: 727-505-0913