Healthcare Provider Details

I. General information

NPI: 1912816851
Provider Name (Legal Business Name): NOVA GROVE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 N YORK ST UNIT 146
ELMHURST IL
60126-1620
US

IV. Provider business mailing address

627 N YORK ST UNIT 146
ELMHURST IL
60126-1620
US

V. Phone/Fax

Practice location:
  • Phone: 985-999-6575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MARC S SIN
Title or Position: BILLING
Credential:
Phone: 985-999-6575