Provider Demographics
NPI:1942577515
Name:NOVENA HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:NOVENA HEALTHCARE SERVICES LLC
Other - Org Name:NOVENA HOMECARE SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:IFEANYI
Authorized Official - Middle Name:TED
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:301-806-8952
Mailing Address - Street 1:8235 LYNDHURST ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-1909
Mailing Address - Country:US
Mailing Address - Phone:301-806-8952
Mailing Address - Fax:301-794-4420
Practice Address - Street 1:8235 LYNDHURST ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-1909
Practice Address - Country:US
Practice Address - Phone:301-806-8952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-25
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1007008251J00000X
253Z00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies