Provider Demographics
NPI:1033786959
Name:NOVA WELLNESS PROGRAM, LLC
Entity Type:Organization
Organization Name:NOVA WELLNESS PROGRAM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:J
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:443-504-3018
Mailing Address - Street 1:2873 TROYER RD
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21161-9321
Mailing Address - Country:US
Mailing Address - Phone:833-337-6682
Mailing Address - Fax:410-692-0143
Practice Address - Street 1:780 W BEL AIR AVE STE C
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-2236
Practice Address - Country:US
Practice Address - Phone:833-337-6682
Practice Address - Fax:410-692-0143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-09
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health