Provider Demographics
NPI:1619213444
Name:INNOVO HEALTHCARE, LLC
Entity Type:Organization
Organization Name:INNOVO HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ALESSANDRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-377-9617
Mailing Address - Street 1:594 OUTPOST CIR STE G
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-7895
Mailing Address - Country:US
Mailing Address - Phone:715-377-9617
Mailing Address - Fax:715-377-9623
Practice Address - Street 1:625 COMMERCE DR STE 200
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-8361
Practice Address - Country:US
Practice Address - Phone:715-377-9617
Practice Address - Fax:715-377-9623
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INNOVO, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-26
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100035850Medicaid
WI100035850Medicaid