Healthcare Provider Details

I. General information

NPI: 1174296131
Provider Name (Legal Business Name): NOVA HEALTHCARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2712 MIDDLEBURG DR STE 104-356
COLUMBIA SC
29204-2415
US

IV. Provider business mailing address

2712 MIDDLEBURG DR STE 104-356
COLUMBIA SC
29204-2415
US

V. Phone/Fax

Practice location:
  • Phone: 843-908-9796
  • Fax:
Mailing address:
  • Phone: 843-908-9796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL BRYANT
Title or Position: DIRECTOR
Credential:
Phone: 843-908-9796