- Enrollment id
- O20130219000081
- Enrollment state
- WI
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1619213444
- Multiple npi flag
- N
- Ccn
- 521597
- Associate id
- 0143476572
- Organization name
- INNOVO HEALTHCARE, LLC
- Doing business as name
- INTERIM HEALTHCARE OF WESTERN WISCONSIN
- Incorporation date
- 2012-04-27
- Incorporation state
- MN
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 4410 GOLF TER
- Address line 2
- STE 202
- City
- EAU CLAIRE
- State
- WI
- Zip code
- 547018699