MEDICARE: NOVASTREAM CORE LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1922944321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVASTREAM CORE LLC

Provider Business Mailing Address
First Line	:	2780 S JONES BLVD STE 221
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5628
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2780 S JONES BLVD STE 221
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5628
Country	:	US
Telephone Number	:	201-649-2038
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DENISE BOLTON-MATHEWS
Credential	:
Telephone Number	:	201-649-2038

Provider Enumeration Date	:	04/27/2026
Last Update Date	:	04/27/2026

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Directions to “NOVASTREAM CORE LLC ” Practice Location

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