Provider Demographics
NPI:1144601899
Name:INNOVATION RECOVERY RESOURCE
Entity Type:Organization
Organization Name:INNOVATION RECOVERY RESOURCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:254-968-5011
Mailing Address - Street 1:260 N BELKNAP ST
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-3449
Mailing Address - Country:US
Mailing Address - Phone:254-968-5011
Mailing Address - Fax:254-968-5012
Practice Address - Street 1:260 N BELKNAP ST
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-3449
Practice Address - Country:US
Practice Address - Phone:254-968-5011
Practice Address - Fax:254-968-5012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder