Provider Demographics
NPI:1356702542
Name:ANOVUS, INC
Entity type:Organization
Organization Name:ANOVUS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-226-8506
Mailing Address - Street 1:805 PINE PARK LN
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-6530
Mailing Address - Country:US
Mailing Address - Phone:904-226-8506
Mailing Address - Fax:
Practice Address - Street 1:805 PINE PARK LN
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-6530
Practice Address - Country:US
Practice Address - Phone:904-226-8506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1095910253Z00000X, 251C00000X, 251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251B00000XAgenciesCase Management