Provider Demographics
NPI:1417273699
Name:NOVA BEHAVIORAL SERVICES, LLC
Entity Type:Organization
Organization Name:NOVA BEHAVIORAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-276-3744
Mailing Address - Street 1:PO BOX 51354
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89435
Mailing Address - Country:US
Mailing Address - Phone:775-276-3744
Mailing Address - Fax:
Practice Address - Street 1:4860 VISTA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-2863
Practice Address - Country:US
Practice Address - Phone:186-683-2301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20101103448320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness