Provider Demographics
NPI:1720208333
Name:NOVA CENTER INC.
Entity Type:Organization
Organization Name:NOVA CENTER INC.
Other - Org Name:114TH
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-761-8614
Mailing Address - Street 1:12604 SOUTH 3RD STREET
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-1616
Mailing Address - Country:US
Mailing Address - Phone:816-761-8614
Mailing Address - Fax:816-765-0622
Practice Address - Street 1:12604 SOUTH 3RD STREET
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-1616
Practice Address - Country:US
Practice Address - Phone:816-761-8614
Practice Address - Fax:816-765-0622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities