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General NPI Number Information
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NPI Number | 1477737112
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Entity Type | Organization
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Legal Business Name | NOVELLA'S PLACE, INC.
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Dates
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Enumeration Date | 12/17/2007
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Last Update Date | 01/12/2008
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Provider Practice Location Address
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Address Line | 2128 OLD MILBURNIE RD
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City | RALEIGH
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State | NC
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Zip | 27604-9642
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Country | US
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Telephone | 919-266-0146
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Fax | 919-266-0146
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Provider Business Mailing Address
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Address Line | 1307 E MILLBROOK RD SUITE C-15
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City | RALEIGH
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State | NC
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Zip | 27609-5476
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Country | US
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Telephone | 919-427-1402
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Fax | 919-828-1624
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Authorized Official
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Title or Position | FINANCIAL ADMINISTRATION
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Name | MR. JESSE JAMES BANKS JR.
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Credential |
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Telephone | 919-427-1402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | MHL-032-418
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | MHL-032-418
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License Number State | NC
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