=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750177093
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NOVELLA IN-HOME CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2025
-----------------------------------------------------
Last Update Date | 04/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 E MAIN ST STE 309
-----------------------------------------------------
City | OTTAWA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61350-2900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-640-0810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 E MAIN ST STE 309
-----------------------------------------------------
City | OTTAWA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61350-2900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-640-0810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AGENCY MANAGER/CEO
-----------------------------------------------------
Name | JAMIE MILLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 815-640-0810
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------