Healthcare Provider Details

I. General information

NPI: 1245721307
Provider Name (Legal Business Name): NOVA SENIOR HOME CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14301 SULLYFIELD CIR STE 202
CHANTILLY VA
20151-1630
US

IV. Provider business mailing address

3769 VERNACCHIA DR
CHANTILLY VA
20151-3269
US

V. Phone/Fax

Practice location:
  • Phone: 703-899-4422
  • Fax:
Mailing address:
  • Phone: 703-899-4422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEEPA KEWALRAMANI
Title or Position: PRESIDENT
Credential:
Phone: 703-899-4422