Healthcare Provider Details

I. General information

NPI: 1083433379
Provider Name (Legal Business Name): NOVA HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2024
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S 70TH ST STE 200
LINCOLN NE
68506-1568
US

IV. Provider business mailing address

7329 SHERMAN ST
LINCOLN NE
68506-4622
US

V. Phone/Fax

Practice location:
  • Phone: 531-233-5550
  • Fax: 531-233-5550
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: SAM HASAN
Title or Position: CEO
Credential:
Phone: 402-309-3005