Provider Demographics
NPI:1407886229
Name:NOVA INC.
Entity Type:Organization
Organization Name:NOVA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIDGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-734-8803
Mailing Address - Street 1:PO BOX 11147
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27532-1147
Mailing Address - Country:US
Mailing Address - Phone:919-734-8803
Mailing Address - Fax:919-735-6825
Practice Address - Street 1:2002 SHACKLE FORD RD
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-8917
Practice Address - Country:US
Practice Address - Phone:252-233-0491
Practice Address - Fax:252-233-0495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC322D00000X
NCNHL-054-013322D00000X
323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603000Medicaid
NC8301286DMedicaid
NC6603013Medicaid
NC6603014Medicaid
NC6603006Medicaid
NC6603011Medicaid
NC8300966Medicaid
NC8300789BMedicaid
NC6005810Medicaid
NC8300789HMedicaid
NC6603010Medicaid