Provider Demographics
NPI:1851760193
Name:NOVA VITAE
Entity Type:Organization
Organization Name:NOVA VITAE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:YADEGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-422-3442
Mailing Address - Street 1:5565 NEWCASTLE LN
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-3121
Mailing Address - Country:US
Mailing Address - Phone:818-925-5985
Mailing Address - Fax:
Practice Address - Street 1:5565 NEWCASTLE LN
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-3121
Practice Address - Country:US
Practice Address - Phone:818-925-5985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-16
Last Update Date:2018-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility