MEDICARE: NOVA CENTER

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174743785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVA CENTER

Provider Business Mailing Address
First Line	:	8401 HICKMAN MILLS DR
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64132-2513
Country	:	US
Telephone Number	:	816-761-8614
Fax Number	:	816-765-0622

Provider Business Practice Location Address
First Line	:	8401 HICKMAN MILLS DR
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64132-2513
Country	:	US
Telephone Number	:	816-761-8614
Fax Number	:	816-765-0622

Authorized Official
Title or Position	:	CEO
Name	:	MR. CARY WILLIAMS
Credential	:
Telephone Number	:	816-761-8614

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	05/14/2014

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Directions to “NOVA CENTER ” Practice Location

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