Provider Demographics
NPI:1477245744
Name:NOVA LEAP HEALTH MA III
Entity Type:Organization
Organization Name:NOVA LEAP HEALTH MA III
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-665-9058
Mailing Address - Street 1:235 GREENFIELD RD STE 6
Mailing Address - Street 2:
Mailing Address - City:S DEERFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01373-9756
Mailing Address - Country:US
Mailing Address - Phone:413-665-9058
Mailing Address - Fax:
Practice Address - Street 1:235 GREENFIELD RD STE 6
Practice Address - Street 2:
Practice Address - City:S DEERFIELD
Practice Address - State:MA
Practice Address - Zip Code:01373-9756
Practice Address - Country:US
Practice Address - Phone:413-665-9058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care