Provider Demographics
NPI:1477737112
Name:NOVELLA'S PLACE, INC.
Entity Type:Organization
Organization Name:NOVELLA'S PLACE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:919-427-1402
Mailing Address - Street 1:1307 E MILLBROOK RD
Mailing Address - Street 2:SUITE C-15
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-5476
Mailing Address - Country:US
Mailing Address - Phone:919-427-1402
Mailing Address - Fax:919-828-1624
Practice Address - Street 1:2128 OLD MILBURNIE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-9642
Practice Address - Country:US
Practice Address - Phone:919-266-0146
Practice Address - Fax:919-266-0146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2008-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-032-418311ZA0620X, 320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home