Provider Demographics
NPI:1013608231
Name:INNOVA RECOVERY
Entity Type:Organization
Organization Name:INNOVA RECOVERY
Other - Org Name:INNOVA RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KASI
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:210-838-0090
Mailing Address - Street 1:1842 LOCKHILL SELMA RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1559
Mailing Address - Country:US
Mailing Address - Phone:210-838-0090
Mailing Address - Fax:210-881-9022
Practice Address - Street 1:446 SE WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4141
Practice Address - Country:US
Practice Address - Phone:210-254-3618
Practice Address - Fax:210-881-9022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-18
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health