=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497940837
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NOVA CENTER INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2007
-----------------------------------------------------
Last Update Date | 09/11/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12604 3RD ST
-----------------------------------------------------
City | GRANDVIEW
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64030-1616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-761-8614
-----------------------------------------------------
Fax | 816-765-0622
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12604 3RD ST
-----------------------------------------------------
City | GRANDVIEW
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64030-1616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-761-8614
-----------------------------------------------------
Fax | 816-765-0622
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. CARY L WILLIAMS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 816-761-8614
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------