MEDICARE: INNOVATIONS, 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	385H00000X	Respite Care

General Provider Information

NPI Number	:	1992245377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVATIONS, LLC

Provider Business Mailing Address
First Line	:	2731 1/2 S SHERMAN ST
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80113-1618
Country	:	US
Telephone Number	:	507-254-1775
Fax Number	:

Provider Business Practice Location Address
First Line	:	2731 1/2 S SHERMAN ST
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80113-1618
Country	:	US
Telephone Number	:	507-254-1775
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	KELSEY A STEEDMAN
Credential	:
Telephone Number	:	507-254-1775

Provider Enumeration Date	:	03/03/2017
Last Update Date	:	03/03/2017

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