Provider Demographics
| NPI: | 1720696107 |
|---|---|
| Name: | NOVUS LIVING LLC |
| Entity type: | Organization |
| Organization Name: | NOVUS LIVING LLC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OWNER |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | ELISSA |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | JABBOURY |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 248-789-0999 |
| Mailing Address - Street 1: | 5555 APPLE RIDGE TRL |
| Mailing Address - Street 2: | |
| Mailing Address - City: | WEST BLOOMFIELD |
| Mailing Address - State: | MI |
| Mailing Address - Zip Code: | 48322-1776 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 248-789-0999 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 2121 S NEWBURGH RD |
| Practice Address - Street 2: | |
| Practice Address - City: | WESTLAND |
| Practice Address - State: | MI |
| Practice Address - Zip Code: | 48186-3973 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 734-331-6390 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2020-07-21 |
| Last Update Date: | 2024-06-05 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility | |
| No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | |
| No | 3104A0625X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Mental Illness |
| No | 3104A0630X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Behavioral Disturbances |
| No | 310500000X | Nursing & Custodial Care Facilities | Intermediate Care Facility, Mental Illness | |
| No | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| No | 320700000X | Residential Treatment Facilities | Residential Treatment Facility, Physical Disabilities | |
| No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | |
| No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
