Healthcare Provider Details

I. General information

NPI: 1235511239
Provider Name (Legal Business Name): NOVITCO HEALTH CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 THOMAS CIRCLE
SALEM MA
01970
US

IV. Provider business mailing address

13 THOMAS CIRCLE
SALEM MA
01970
US

V. Phone/Fax

Practice location:
  • Phone: 781-854-8443
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER NGOZI MORDI
Title or Position: PRESIDENT/CEO
Credential:
Phone: 781-854-8443