Healthcare Provider Details

I. General information

NPI: 1407540164
Provider Name (Legal Business Name): NUVO HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1618 B RHODE ISLAND AVENUE NE
WASHINGTON DC
20018
US

IV. Provider business mailing address

1618 B RHODE ISLAND AVENUE NE
WASHINGTON DC
20018
US

V. Phone/Fax

Practice location:
  • Phone: 240-687-4019
  • Fax:
Mailing address:
  • Phone: 240-687-4019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SERGE GOUDOU
Title or Position: OWNER
Credential:
Phone: 240-687-4019