Organization
NOVA INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACEY PRIDGEN (CFO)
(919) 734-8803
Entity
Organization
Contact information
Practice address
2002 SHACKLE FORD RD, KINSTON, NC 28504-8917
(252) 233-0491
(252) 233-0495
Mailing address
PO BOX 11147, GOLDSBORO, NC 27532-1147
(919) 734-8803
(919) 735-6825
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
NHL-054-013
NC
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
NC
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6005810
—
NC
05
—
6603000
—
NC
05
—
6603006
—
NC
05
—
6603010
—
NC
05
—
6603011
—
NC
05
—
6603013
—
NC
05
—
6603014
—
NC
05
—
8300789B
—
NC
05
—
8300789H
—
NC
05
—
8300966
—
NC
05
—
8301286D
—
NC
Enumeration date
07/04/2006
Last updated
09/27/2024
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