Provider Demographics
NPI:1821281742
Name:NOVA NURSES HOME CARE AGENCY, LLC
Entity Type:Organization
Organization Name:NOVA NURSES HOME CARE AGENCY, LLC
Other - Org Name:NORTHERN VIRGINIA NURSES FOR ELDERS LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-865-5452
Mailing Address - Street 1:4020 WILLIAMSBURG COURT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-1139
Mailing Address - Country:US
Mailing Address - Phone:703-865-5452
Mailing Address - Fax:
Practice Address - Street 1:4020 WILLIAMSBURG COURT
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-1139
Practice Address - Country:US
Practice Address - Phone:703-865-5452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health