Healthcare Provider Details

I. General information

NPI: 1457599086
Provider Name (Legal Business Name): NOVA THERAPUTIC COMMUNITY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 02/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3483 LARIMORE AVE
OMAHA NE
68111-2383
US

IV. Provider business mailing address

3483 LARIMORE AVE
OMAHA NE
68111-2383
US

V. Phone/Fax

Practice location:
  • Phone: 402-455-8303
  • Fax: 402-455-7050
Mailing address:
  • Phone: 402-455-8303
  • Fax: 402-455-7050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number StateNE

VIII. Authorized Official

Name: MRS. ELEANOR DEVLIN
Title or Position: EXECUTIVE DIRECTOR
Credential: LMHP
Phone: 402-455-8303