Provider Demographics
NPI:1891389755
Name:NOVA ONE HOME HEALTHCARE CORPORATION
Entity Type:Organization
Organization Name:NOVA ONE HOME HEALTHCARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARCK ANTON
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-829-8903
Mailing Address - Street 1:1440 N HARBOR BLVD STE 924A
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4127
Mailing Address - Country:US
Mailing Address - Phone:714-770-0152
Mailing Address - Fax:
Practice Address - Street 1:1440 N HARBOR BLVD STE 924A
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4127
Practice Address - Country:US
Practice Address - Phone:714-770-0152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health