Healthcare Provider Details

I. General information

NPI: 1942577515
Provider Name (Legal Business Name): NOVENA HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2011
Last Update Date: 11/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8235 LYNDHURST ST
LAUREL MD
20724-1909
US

IV. Provider business mailing address

8235 LYNDHURST ST
LAUREL MD
20724-1909
US

V. Phone/Fax

Practice location:
  • Phone: 301-806-8952
  • Fax:
Mailing address:
  • Phone: 301-806-8952
  • Fax: 301-794-4420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number1007008
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: IFEANYI TED PHILLIPS
Title or Position: PRESIDENT/CEO
Credential: MBA
Phone: 301-806-8952