Provider Demographics
NPI:1932839453
Name:NOVA ALL STAR, INC.
Entity Type:Organization
Organization Name:NOVA ALL STAR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTILLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-882-7736
Mailing Address - Street 1:5525 ROSE THICKET ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-1653
Mailing Address - Country:US
Mailing Address - Phone:702-882-7736
Mailing Address - Fax:702-633-8928
Practice Address - Street 1:5525 ROSE THICKET ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-1653
Practice Address - Country:US
Practice Address - Phone:702-882-7736
Practice Address - Fax:702-633-8928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility