Healthcare Provider Details

I. General information

NPI: 1164774063
Provider Name (Legal Business Name): NOVA HEALTHCARE GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2012
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

377 CLONCE ST
WEBER CITY VA
24290-7269
US

IV. Provider business mailing address

23700 COMMERCE PARK
BEACHWOOD OH
44122-5827
US

V. Phone/Fax

Practice location:
  • Phone: 276-477-5640
  • Fax: 276-386-2597
Mailing address:
  • Phone: 216-292-5706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH2516
License Number StateVA

VIII. Authorized Official

Name: WILLIAM WEISBERG
Title or Position: PRESIDENT
Credential:
Phone: 216-292-5706