Healthcare Provider Details

I. General information

NPI: 1679416051
Provider Name (Legal Business Name): NOVAHOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2026
Last Update Date: 04/11/2026
Certification Date: 04/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 UNION ST UNIT 3
EVERETT MA
02149-5330
US

IV. Provider business mailing address

PO BOX 14053
WEST ALLIS WI
53214-0053
US

V. Phone/Fax

Practice location:
  • Phone: 774-381-8964
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY ODIVIN
Title or Position: PRESIDENT
Credential: LNHA
Phone: 774-381-8964