NOVA IC, INC. (NPI# 1669611471) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669611471 |
| Entity Type | Organization |
| Organization Name | NOVA IC, INC. |
| Other Organization Name | WASHINGTON STREET EAST GROUP HOME |
| Practice Address |
407 W. Washington Street Lagrange NC 28551-1623 |
| 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-054-038 | NC | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 340608V | 05 |
| Other Name | Type Code |
|---|---|
| Washington Street East Group Home | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841439650 | Nova Ic, Inc. | Intermediate Care Facility, Mentally Retarded | 135 Daughtry Field Road, Mount Olive, NC 28365-7347 | 2009-02-18 |
| 1447499330 | Nova Ic, Inc. | Intermediate Care Facility, Mentally Retarded | 405 W Washington St, La Grange, NC 28551-1623 | 2009-02-17 |
| Street Address |
407 W. WASHINGTON STREET |
| City | LAGRANGE |
| State | NC |
| Zip Code | 28551-1623 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992229215 | Christopher Webster | Physical Therapist | 3870 Falling Creek Road, Legrange, NC 28551 | 2017-07-28 |
| 1437527082 | Tanger Lee Jones | Counselor | 197 Brook Meadow Lane, Lagrange, NC 28551 | 2015-09-11 |
| 1235362161 | Daniel's Choices Youth Development, Inc. | Community/Behavioral Health | 525 Arba Jason Rd., La Grange, NC 28551 | 2009-08-26 |
| 1518942135 | Marjorie R Rachide | Nurse Practitioner | 101 South Carey Street, Lagrange, NC 28551 | 2005-12-07 |
| 1447499330 | Nova Ic, Inc. | Intermediate Care Facility, Mentally Retarded | 405 W Washington St, La Grange, NC 28551-1623 | 2009-02-17 |
| 1629259676 | Advantage Care of North Carolina, LLC | Case Management | 111 S Caswell St, La Grange, NC 28551-1707 | 2007-11-19 |
| 1629118013 | Waters' Provider Care Services, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 104 W James St, La Grange, NC 28551-1727 | 2007-02-07 |
| 1568586808 | Ant Mary's Family Care | Custodial Care Facility | 127 E Railroad St, La Grange, NC 28551-1741 | 2007-03-19 |
| 1720063340 | Carl L Haynes Jr. | Family Medicine | 101 S Carey St, La Grange, NC 28551-1805 | 2005-12-07 |
| 1265809990 | Laura W Shearer | Nurse Practitioner | 101 S Carey St, La Grange, NC 28551-1805 | 2015-08-28 |
| Find all providers in zip 28551 | ||||
| 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 |
|---|---|---|---|---|
| 1548874589 | Res-care Ohio, Inc. | Intermediate Care Facility, Mentally Retarded | 448 Opportunity Way, Lagrange, OH 44050-9021 | 2020-09-08 |
| 1346854890 | Res-care Ohio, Inc. | Intermediate Care Facility, Mentally Retarded | 426 Opportunity Way, Lagrange, OH 44050-9021 | 2020-09-02 |
| 1568685089 | Alternative Lifestyles, Inc. | Intermediate Care Facility, Mentally Retarded | 995 N 250 W, Lagrange, IN 46761-9459 | 2007-04-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730702937 | Gha Autism Supports | Intermediate Care Facility, Mentally Retarded | 44012 Morrow Mountain Rd, Albemarle, NC 28001-8616 | 2020-05-21 |
| 1811517774 | Educare Community Living Corporation-north Carolina | Intermediate Care Facility, Mentally Retarded | 834 Tyvola Rd Ste 116, Charlotte, NC 28217-3542 | 2020-04-21 |
| 1598125460 | Rha Health Services Nc LLC | Intermediate Care Facility, Mentally Retarded | 410 N Mineral Springs Rd, Durham, NC 27703-3618 | 2016-03-04 |
| 1023478294 | Rha Health Services Nc, LLC | Intermediate Care Facility, Mentally Retarded | 619 Ray Ave, Hendersonville, NC 28792-2668 | 2016-03-02 |
| 1740649417 | Rha Health Services Nc, LLC | Intermediate Care Facility, Mentally Retarded | 310 Locust Street, West Jefferson, NC 28694 | 2016-02-23 |
| 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.