Provider Demographics
NPI:1598833659
Name:NOVA CARE
Entity Type:Organization
Organization Name:NOVA CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:TEKELA
Authorized Official - Middle Name:ROCHELLE
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:773-788-9374
Mailing Address - Street 1:5405 S HARLEM AVE # 07
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2205
Mailing Address - Country:US
Mailing Address - Phone:773-788-9374
Mailing Address - Fax:773-788-9378
Practice Address - Street 1:5405 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2205
Practice Address - Country:US
Practice Address - Phone:773-788-9374
Practice Address - Fax:773-788-9378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70012853305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service