Provider Demographics
NPI:1518215193
Name:INNOVATIVE VALLEY HOME HEALTH LLC
Entity Type:Organization
Organization Name:INNOVATIVE VALLEY HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELEONZETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BONILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-245-6050
Mailing Address - Street 1:1510 S EXPRESSWAY 83 STE B
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-6302
Mailing Address - Country:US
Mailing Address - Phone:956-873-4483
Mailing Address - Fax:956-440-0856
Practice Address - Street 1:1510 S EXPRESSWAY 83 STE B
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-6302
Practice Address - Country:US
Practice Address - Phone:956-245-1235
Practice Address - Fax:956-440-0856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27449251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202804501Medicaid
TXA6103Medicare PIN