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General NPI Number Information
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NPI Number | 1063085975
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Entity Type | Organization
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Legal Business Name | NOVA HEALTH AND WELLNESS INC
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Dates
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Enumeration Date | 07/19/2021
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Last Update Date | 01/21/2022
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Provider Practice Location Address
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Address Line | 6575 WEST LOOP S STE 500
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City | BELLAIRE
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State | TX
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Zip | 77401-3509
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Country | US
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Telephone | 832-479-0212
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Fax | 804-225-0753
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Provider Business Mailing Address
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Address Line | 6575 WEST LOOP S STE 500
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City | BELLAIRE
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State | TX
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Zip | 77401-3509
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Country | US
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Telephone | 832-479-0212
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Fax | 804-225-0753
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Authorized Official
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Title or Position | CEO
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Name | KHIDHRA SMITH POOLE
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Credential | LCSW
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Telephone | 804-551-7363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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