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General NPI Number Information
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NPI Number | 1619777984
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Entity Type | Organization
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Legal Business Name | INNOVACARE, LLC
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Dates
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Enumeration Date | 03/17/2025
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 24402 STATE ROAD 54 STE 1914
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City | LUTZ
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State | FL
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Zip | 33559-7303
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Country | US
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Telephone | 727-505-0913
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Fax |
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Provider Business Mailing Address
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Address Line | 32135 POND APPLE BND
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City | SAN ANTONIO
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State | FL
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Zip | 33576-7380
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Country | US
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Telephone | 727-505-0913
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SORAYA DEL VALLE MARCANO CASTILLO
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Credential |
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Telephone | 727-505-0913
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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