Organization
NOVA INC
Active
Other names
Oakwood Facility
Organization subpart
No
Provider details
NPI number
Authorized official
TRACEY PRIDGEN (CFO)
(919) 734-8803
Entity
Organization
Contact information
Practice address
2002 D-E SHACKLEFORD ROAD, KINSTON, NC 28502-7476
(252) 233-0491
(252) 233-0495
Mailing address
PO BOX 11147, GOLDSBORO, NC 27532-1147
(252) 233-0491
(252) 233-0495
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
MHL-054-126
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0032H
BCBSNC
NC
05
—
3404551
—
NC
Enumeration date
09/01/2009
Last updated
09/27/2024
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