Organization
GARY GREEN
Active
Other names
Nova Development Centers (Arch Way House)
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY M GREEN (LICENSEE/OWNER)
(530) 226-0375
Entity
Organization
Contact information
Practice address
1494 ARCH WAY, CHICO, CA 95973
(530) 226-0375
(530) 365-1609
Mailing address
PO BOX 492478, REDDING, CA 96049
(530) 226-0375
(530) 365-1609
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
230000294
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LTC80241F
—
CA
Enumeration date
02/14/2006
Last updated
07/31/2008
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