Provider Demographics
NPI:1467168773
Name:NOVA BEHAVIORAL SERVICES LLC
Entity Type:Organization
Organization Name:NOVA BEHAVIORAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DENIS AGUILAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-215-9531
Mailing Address - Street 1:1750 NW 107TH AVE UNIT NM5
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2984
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1750 NW 107TH AVE UNIT NM5
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:FL
Practice Address - Zip Code:33172-2984
Practice Address - Country:US
Practice Address - Phone:305-215-9531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-30
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty