NOVA IC, INC. (NPI# 1841439650) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841439650 |
| Entity Type | Organization |
| Organization Name | NOVA IC, INC. |
| Other Organization Name | DAUGHTRY FIELD ROAD GROUP HOME |
| Practice Address |
135 Daughtry Field Road Mount Olive NC 28365-7347 |
| 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-096-037 | NC | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 340609R | 05 |
| Other Name | Type Code |
|---|---|
| Daughtry Field Road Group Home | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669611471 | Nova Ic, Inc. | Intermediate Care Facility, Mentally Retarded | 407 W. Washington Street, Lagrange, NC 28551-1623 | 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 |
135 DAUGHTRY FIELD ROAD |
| City | MOUNT OLIVE |
| State | NC |
| Zip Code | 28365-7347 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639782709 | Courtney Bullard Conn | Dentist | 315 Hwy 55, Mount Olive, NC 28365 | 2020-08-28 |
| 1740836485 | Brittany Leigh Spence | Nurse Practitioner | 325 Nc-55 West, Mt Olive, NC 28365 | 2019-08-16 |
| 1265859847 | Lisa B Ezzell-weeks | Pharmacist | 308 Nc 55 West, Mount Olive, NC 28365 | 2014-03-21 |
| 1962844720 | Terry Louise Price | Counselor | 110 Sw Center Street, Mount Olive, NC 28365 | 2013-07-22 |
| 1396089173 | Karen Lane | Physical Therapy Assistant | 2221 Nc 55 Eas5t, Mount Olive, NC 28365 | 2012-11-19 |
| 1760726475 | Sundance | Skilled Nursing Facility | 228 Smith Chapel Road, Mount Olive, NC 28365 | 2012-11-19 |
| 1356633531 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 1103 N Breazeale Ave, Mount Olive, NC 28365 | 2011-05-06 |
| 1780995175 | Darren Edward Stevens | Pharmacist | 308 Nc 55w, Mount Olive, NC 28365 | 2010-06-30 |
| 1760719348 | Hana Kim | Physician Assistant | 325 Nc Highway 55 West, Mount Olive, NC 28365 | 2009-11-03 |
| 1376684696 | Michelle E Honeycutt | Speech-Language Pathologist | 429 Hwy E, Mt Olive, NC 28365 | 2007-02-09 |
| Find all providers in zip 28365 | ||||
| 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 |
|---|---|---|---|---|
| 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 | ||||
| City | MOUNT OLIVE |
| Zip Code | 28365 |
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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.