Provider Demographics
NPI:1568787703
Name:NOVA HOME HEALTHCARE, INC.
Entity Type:Organization
Organization Name:NOVA HOME HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SULTAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SURTI
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:630-964-1222
Mailing Address - Street 1:6900 MAIN STREET
Mailing Address - Street 2:161
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516
Mailing Address - Country:US
Mailing Address - Phone:630-964-1222
Mailing Address - Fax:630-541-6023
Practice Address - Street 1:6900 MAIN STREET
Practice Address - Street 2:SUITE#: 161
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516
Practice Address - Country:US
Practice Address - Phone:630-964-1222
Practice Address - Fax:630-964-6440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-31
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL1011323251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL148263Medicare Oscar/Certification