NOVA IC INC. NPI 1669611471

NPI Information

NPI: 1669611471
Provider Name: NOVA IC, INC.

Other Name: WASHINGTON STREET EAST GROUP HOME

Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization
Address:
407 W. WASHINGTON STREET
LAGRANGE, NC
ZIP 28551
Phone: (919) 734-8803
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NOVA IC, INC. is an intermediate care facility mentally retarded in Lagrange, NC. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. NOVA IC, INC. NPI is 1669611471. The provider is registered as an organization entity type.
The provider Other Name Is Washington Street East Group Home.

The provider's business location address is:

407 W. WASHINGTON STREET
LAGRANGE, NC
ZIP 28551-623
Phone: (919) 734-8803
Fax: (919) 735-6825

The provider's authorized official is Tracey Pridgen .
The authorized official title is Cfo and has the following contact phone number (919) 734-8803.

The enumeration date for this NPI number is 2/18/2009 and was last updated on 9/29/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	315P00000X	Intermediate Care Facility, Intellectual Disabilities		MHL-054-038	NORTH CAROLINA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	340608V	MEDICAID	NORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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