Provider Demographics
NPI:1376651588
Name:NOVA SENIOR SERVICES
Entity Type:Organization
Organization Name:NOVA SENIOR SERVICES
Other - Org Name:RESPONSELINK OF NORTHRN VIRGINIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:F
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-283-1328
Mailing Address - Street 1:PO BOX 1700
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20177-1700
Mailing Address - Country:US
Mailing Address - Phone:571-283-1328
Mailing Address - Fax:571-258-0112
Practice Address - Street 1:20683 MANDALAY CT
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-2836
Practice Address - Country:US
Practice Address - Phone:571-283-1328
Practice Address - Fax:571-258-0112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010022649Medicaid