MEDICARE: INNOVA, 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	:	1093914251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVA, LLC

Provider Business Mailing Address
First Line	:	4100 PERIMETER CTR DR
Second Line	:	SUITE 210
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-2326
Country	:	US
Telephone Number	:	405-418-2974
Fax Number	:	866-453-4968

Provider Business Practice Location Address
First Line	:	4100 PERIMETER CTR DR
Second Line	:	SUITE 210
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-2326
Country	:	US
Telephone Number	:	405-418-2974
Fax Number	:	866-453-4968

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. BILL SANDERS
Credential	:
Telephone Number	:	405-418-2974

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	08/02/2011

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