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General NPI Number Information
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NPI Number | 1003711268
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Entity Type | Organization
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Legal Business Name | NOVA CLINIC LLC
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Dates
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Enumeration Date | 10/08/2026
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Last Update Date | 10/08/2026
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Provider Practice Location Address
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Address Line | 5275 EDINA INDUSTRIAL BLVD STE 230
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City | EDINA
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State | MN
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Zip | 55439-2912
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Country | US
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Telephone | 252-469-0022
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Fax |
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Provider Business Mailing Address
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Address Line | 5275 EDINA INDUSTRIAL BLVD STE 230
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City | EDINA
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State | MN
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Zip | 55439-2912
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Country | US
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Telephone | 252-469-0022
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. AHMED JAMA
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Credential |
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Telephone | 252-469-0022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | NULL
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