Provider Demographics
NPI:1164031688
Name:NOVA HOUSE LLC
Entity Type:Organization
Organization Name:NOVA HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGNANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-654-7987
Mailing Address - Street 1:313 STEVENS AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2632
Mailing Address - Country:US
Mailing Address - Phone:413-654-7987
Mailing Address - Fax:
Practice Address - Street 1:313 STEVENS AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2632
Practice Address - Country:US
Practice Address - Phone:413-654-7987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health