1346471265 NPI number — NOVA BEHAVIORAL HEALTHCARE CORP.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346471265 NPI number — NOVA BEHAVIORAL HEALTHCARE CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NOVA BEHAVIORAL HEALTHCARE CORP.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346471265
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11147
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOLDSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27532-1147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-734-8803
Provider Business Mailing Address Fax Number:
919-735-6825

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2002 SHACKLEFORD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINSTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28504-8917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-233-0491
Provider Business Practice Location Address Fax Number:
252-233-0495
Provider Enumeration Date:
07/28/2009

Additional Information

Authorized Official

Authorized Official Last Name:
PRIDGEN
Authorized Official First Name:
TRACEY
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
919-734-8803

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8300789H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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