Healthcare Provider Details

I. General information

NPI: 1154541761
Provider Name (Legal Business Name): NOVA CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 HICKMAN MILLS DR
KANSAS CITY MO
64132-2513
US

IV. Provider business mailing address

8401 HICKMAN MILLS DR
KANSAS CITY MO
64132-2513
US

V. Phone/Fax

Practice location:
  • Phone: 816-761-8614
  • Fax: 816-765-0622
Mailing address:
  • Phone: 816-761-8614
  • Fax: 816-765-0622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number902
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number902
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. CARY WILLIAMS
Title or Position: CEO
Credential:
Phone: 816-761-8614