MEDICARE: NOVA HOME HEALTH AGENCY INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency		FL

General Provider Information

NPI Number	:	1023299187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVA HOME HEALTH AGENCY INC.

Provider Business Mailing Address
First Line	:	410 W 29TH ST STE B
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-5728
Country	:	US
Telephone Number	:	305-819-1905
Fax Number	:	305-819-1906

Provider Business Practice Location Address
First Line	:	410 W 29TH ST STE B
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-5728
Country	:	US
Telephone Number	:	305-819-1905
Fax Number	:	305-819-1906

Authorized Official
Title or Position	:	CFO/OWNER
Name	:	MISS MARYBEL PEREZ
Credential	:
Telephone Number	:	305-819-1905

Provider Enumeration Date	:	11/16/2007
Last Update Date	:	11/16/2007

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