Provider Demographics
NPI:1063085975
Name:NOVA HEALTH AND WELLNESS INC
Entity type:Organization
Organization Name:NOVA HEALTH AND WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KHIDHRA
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:POOLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-551-7363
Mailing Address - Street 1:6575 WEST LOOP S STE 500
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3509
Mailing Address - Country:US
Mailing Address - Phone:832-479-0212
Mailing Address - Fax:804-225-0753
Practice Address - Street 1:6575 WEST LOOP S STE 500
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3509
Practice Address - Country:US
Practice Address - Phone:832-479-0212
Practice Address - Fax:804-225-0753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-19
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes251B00000XAgenciesCase Management
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder