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General NPI Number Information
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NPI Number | 1417273699
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Entity Type | Organization
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Legal Business Name | NOVA BEHAVIORAL SERVICES, LLC
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Dates
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Enumeration Date | 04/14/2010
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Last Update Date | 08/28/2012
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Provider Practice Location Address
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Address Line | 4860 VISTA BLVD SUITE 200
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City | SPARKS
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State | NV
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Zip | 89436-2863
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Country | US
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Telephone | 186-683-2301
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 51354
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City | SPARKS
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State | NV
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Zip | 89435
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Country | US
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Telephone | 775-276-3744
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | KEVIN CUMMINGS
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Credential |
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Telephone | 775-276-3744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | NV20101103448
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License Number State | NV
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