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General NPI Number Information
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NPI Number | 1790036309
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Entity Type | Organization
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Legal Business Name | NOVA BEHAVIORAL SERVICES
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Dates
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Enumeration Date | 09/21/2012
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Last Update Date | 09/21/2012
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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 | 866-832-3015
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Fax | 775-737-4332
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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 | 89435-1354
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Country | US
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Telephone | 866-832-3015
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Fax | 775-737-4332
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MATHIAS X CONE
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Credential |
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Telephone | 18668323015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | NV20101103448
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License Number State | NV
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