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General NPI Number Information
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NPI Number | 1154362093
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Entity Type | Organization
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Legal Business Name | NOVA SKILLED HOME HEALTH, INC.
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 09/22/2008
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Provider Practice Location Address
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Address Line | 8111 BEVERLY BLVD SUITE 306
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City | LOS ANGELES
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State | CA
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Zip | 90048-4525
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Country | US
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Telephone | 323-658-6232
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Fax | 323-658-6406
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Provider Business Mailing Address
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Address Line | 8111 BEVERLY BLVD SUITE 306
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City | LOS ANGELES
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State | CA
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Zip | 90048-4525
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Country | US
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Telephone | 323-658-6232
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Fax | 323-658-6406
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Authorized Official
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Title or Position | CFO
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Name | BORIS MAXIMOV
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Credential | MCS
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Telephone | 323-658-6232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 980001636
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License Number State | CA
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