NOVA-IC, INC. (NPI# 1043459852) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043459852 |
| Entity Type | Organization |
| Organization Name | NOVA-IC, INC. |
| Other Organization Name | HOLLY STREET HOME |
| Practice Address |
1509 Holly Street Goldsboro NC 27534-3033 |
| Mailing Address |
Po Box 11077 Goldsboro NC 27532-1077 |
| Practice Telephone | 9197354736 |
| Practice Fax Number | 9197356825 |
| Mailing Telephone | 9197354736 |
| Mailing Fax Number | 9197356825 |
| Enumeration Date | 2009-02-18 |
| Last Update Date | 2015-12-17 |
| Authorized Official Name | MR. JOHN E. FORD (CEO) |
| Authorized Official Telephone | 9197358887 |
| Authorized Official Credential | PH.D |
| Is Organization Subpart | Y |
| Parent Organization Name | NOVA-IC, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | MHL-096-114 | NC | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 3406312 | 05 |
| Other Name | Type Code |
|---|---|
| Holly street Home | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750684015 | Nova-ic, Inc. | Community/Behavioral Health | 1216 North Dr, Goldsboro, NC 27534-1858 | 2010-12-08 |
| 1124334339 | Nova-ic, Inc. | Case Management | 2307 Norwood Ave Ste G, Goldsboro, NC 27534-1601 | 2010-08-25 |
| 1831418185 | Nova-ic, Inc. | Psychologist | 2307 Norwood Ave Ste D, Goldsboro, NC 27534-1601 | 2010-05-26 |
| 1841519196 | Nova-ic, Inc. | Community/Behavioral Health | 2002 C Shackleford Road, Kinston, NC 28504-7476 | 2010-05-26 |
| 1477882249 | Nova-ic, Inc. | Psychoanalyst | 2307 Norwood Ave Ste A, Goldsboro, NC 27534-1601 | 2009-12-08 |
| 1811136617 | Nova-ic, Inc. | Intermediate Care Facility, Mentally Retarded | 195 Airport Road, Goldsboro, NC 27530-8086 | 2009-02-18 |
| 1972742781 | Nova-ic, Inc. | Intermediate Care Facility, Mentally Retarded | 3801 Us 117 North, Goldsboro, NC 27530-8086 | 2009-02-18 |
| 1699914598 | Nova-ic, Inc. | Intermediate Care Facility, Mentally Retarded | 2510 Norwood Ave, Goldsboro, NC 27534-1671 | 2009-02-17 |
| 1053634824 | Nova-ic, Inc. | Family Medicine | 2307 Norwood Ave Ste A, Goldsboro, NC 27534-1601 | 2010-03-09 |
| Street Address |
1509 HOLLY STREET |
| City | GOLDSBORO |
| State | NC |
| Zip Code | 27534-3033 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457875767 | Trent Jonathan Forshey | Physical Therapist | 2126 Wayne Memorial Dr, Goldsboro, NC 27534 | 2017-07-28 |
| 1336685551 | Wayne Al Holdings, LLC | Assisted Living Facility | 901 West New Hope Rd, Goldsboro, NC 27534 | 2017-01-11 |
| 1952845471 | Latoya Faulk | Social Worker | 121 Carolina Forest Drive, Goldsboro, NC 27534 | 2016-12-19 |
| 1528415841 | Kelby Joseph Sage Durnin | Military Health Care Provider | 1020 Jabara Avenue, Seymour Johnson Afb, NC 27534 | 2016-05-17 |
| 1528490604 | Eric Christian Bourgeois | Physical Therapist | 1101a Gracie Pl, Goldsboro, NC 27534 | 2013-07-31 |
| 1831439165 | Erica Nicole Davis | Optometrist | 20/20 Vision Center 625 North Berkeley Blvd, Suite D, Goldsboro, NC 27534 | 2013-02-23 |
| 1891039236 | Betty Webb Zimmerman | Nurse Practitioner | 204 Cox Blvd, Goldsboro, NC 27534 | 2012-11-26 |
| 1144595265 | Life Recovery Psychological Services | Counselor | 1202-c Wayne Memorial Dr, Goldsboro, NC 27534 | 2012-03-22 |
| 1558596536 | Taylor Home | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 802 Taylor St, Goldsboro, NC 27534 | 2009-05-20 |
| 1780895136 | Sherrie Fennell Edwards | Dietitian, Registered | 1500 Lanely Ave., Seymour Johnson Afb, Golsboro, NC 27534 | 2007-05-25 |
| Find all providers in zip 27534 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609015411 | Nova-ic, Inc | Intermediate Care Facility, Mentally Retarded | 1216 North Drive, Goldsboro, NC 27534-1858 | 2009-02-18 |
| 1811136617 | Nova-ic, Inc. | Intermediate Care Facility, Mentally Retarded | 195 Airport Road, Goldsboro, NC 27530-8086 | 2009-02-18 |
| 1972742781 | Nova-ic, Inc. | Intermediate Care Facility, Mentally Retarded | 3801 Us 117 North, Goldsboro, NC 27530-8086 | 2009-02-18 |
| 1699914598 | Nova-ic, Inc. | Intermediate Care Facility, Mentally Retarded | 2510 Norwood Ave, Goldsboro, NC 27534-1671 | 2009-02-17 |
| 1750435111 | Life, Inc. | Intermediate Care Facility, Mentally Retarded | 407 N William St, Goldsboro, NC 27530-2801 | 2007-01-23 |
| 1730233362 | Life, Inc. | Intermediate Care Facility, Mentally Retarded | 1101 E Walnut St, Goldsboro, NC 27530-5158 | 2007-01-22 |
| 1508902032 | O'berry Neuro-medical Treatment Center | Intermediate Care Facility, Mentally Retarded | 400 Old Smithfield Road, Goldsboro, NC 27530 | 2007-01-30 |
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|---|---|---|---|---|
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| 1598125460 | Rha Health Services Nc LLC | Intermediate Care Facility, Mentally Retarded | 410 N Mineral Springs Rd, Durham, NC 27703-3618 | 2016-03-04 |
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| 1841655453 | Journeys Healthcare | Intermediate Care Facility, Mentally Retarded | 515 Carver Moore Rd, Lake Waccamaw, NC 28450-9713 | 2015-12-24 |
| 1326414665 | Rha North Carolina Mr, Inc. | Intermediate Care Facility, Mentally Retarded | 1388 Lewis Fork Baptist Ch Rd, Ferguson, NC 28624-9080 | 2015-08-20 |
| 1609299916 | Rha Health Services Nc, LLC | Intermediate Care Facility, Mentally Retarded | 1802 Strickland Bridge Rd, Fayetteville, NC 28304-5739 | 2014-01-23 |
| 1861822314 | Voca Corporation of North Carolina | Intermediate Care Facility, Mentally Retarded | 4109 Enoch Dr, Charlotte, NC 28269-2578 | 2013-11-20 |
| 1902144314 | Rouse's Group Home Inc | Intermediate Care Facility, Mentally Retarded | 5820 Nc 135, Stoneville, NC 27048-8478 | 2013-01-18 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.