Provider Demographics
NPI:1164725545
Name:INNOVATIONS HEALTHCARE REHABILITATION, LLC
Entity Type:Organization
Organization Name:INNOVATIONS HEALTHCARE REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORRAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-855-3363
Mailing Address - Street 1:5971 CORNHUSK LN
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932-2303
Mailing Address - Country:US
Mailing Address - Phone:915-855-3363
Mailing Address - Fax:915-855-6100
Practice Address - Street 1:1941 SAUL KLEINFELD DR
Practice Address - Street 2:107
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-3774
Practice Address - Country:US
Practice Address - Phone:915-855-3363
Practice Address - Fax:915-855-6100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3112174400000X
TX1159340174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty