Provider Demographics
NPI:1316132756
Name:NOVA CENTRER INC.
Entity type:Organization
Organization Name:NOVA CENTRER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CARY
Authorized Official - Middle Name:LOGAN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:816-761-8614
Mailing Address - Street 1:12604 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-1616
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12604 3RD ST
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-1616
Practice Address - Country:US
Practice Address - Phone:816-761-8614
Practice Address - Fax:816-765-0622
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOVA CENTRER INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities