Provider Demographics
NPI:1841929619
Name:NOVA THERAPEUTIC MANAGEMENT LLC
Entity type:Organization
Organization Name:NOVA THERAPEUTIC MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-673-5917
Mailing Address - Street 1:4121 OKEMOS RD STE 10
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3220
Mailing Address - Country:US
Mailing Address - Phone:317-250-6200
Mailing Address - Fax:314-667-6915
Practice Address - Street 1:4121 OKEMOS RD STE 10
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3220
Practice Address - Country:US
Practice Address - Phone:317-250-6200
Practice Address - Fax:314-667-6915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation