Provider Demographics
NPI:1639790686
Name:NOVUMU, INC.
Entity Type:Organization
Organization Name:NOVUMU, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BEVILACQUA
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:765-537-8480
Mailing Address - Street 1:2487 CITRUS GARDEN CIR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2386
Mailing Address - Country:US
Mailing Address - Phone:760-547-4547
Mailing Address - Fax:
Practice Address - Street 1:5446 BOULDER HWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-6069
Practice Address - Country:US
Practice Address - Phone:765-537-8480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health