Provider Demographics
NPI:1376692376
Name:NOVA TREATMENT COMMUNITY, INC.
Entity Type:Organization
Organization Name:NOVA TREATMENT COMMUNITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON-HINTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-455-8303
Mailing Address - Street 1:8502 MORMON BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68152-1929
Mailing Address - Country:US
Mailing Address - Phone:402-455-8303
Mailing Address - Fax:402-455-7050
Practice Address - Street 1:8502 MORMON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68152-1929
Practice Address - Country:US
Practice Address - Phone:402-455-8303
Practice Address - Fax:402-455-7050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE251S00000X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026029900Medicaid