Provider Demographics
NPI:1255699864
Name:NOVAGENESIS HEALTH SERVICES
Entity type:Organization
Organization Name:NOVAGENESIS HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:HARBISON-BLEKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-946-7877
Mailing Address - Street 1:432 WINDROSE WAY
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-7442
Mailing Address - Country:US
Mailing Address - Phone:619-946-7877
Mailing Address - Fax:
Practice Address - Street 1:432 WINDROSE WAY
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-7442
Practice Address - Country:US
Practice Address - Phone:619-946-7877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA164W00000X251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care