NPIMap

Organization Active NPI

Nova Behavioral Health, Inc.

  • Substance Abuse Rehabilitation Facility
  • Dayton, OH
National Provider Identifier
1164782017
Registry record updated May 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
1407 Issued in OH
Legal business name
NOVA BEHAVIORAL HEALTH, INC.
Practice address
732 Beckman St
Dayton, OH 45410-2165
Phone
(937) 253-1680
Fax
(937) 253-8990
NPI assigned
May 25, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 25, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. John W Goris, MS, LSW, LPCC-SCNPI 1407216476
Title
Ceo
Phone
(937) 253-1680

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X 10-2063 OH
Substance Abuse Rehabilitation Facility 324500000X 1407 OH Primary

Addresses

Primary practice location

732 Beckman St
Dayton, OH 45410-2165

Mailing address

732 Beckman St
Dayton, OH 45410-2165
Phone (937) 253-1680

Other identifiers 1

IdentifierTypeStateIssuer
2942632MedicaidOH

Other names 1

  • Nova House Association, Inc. Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Nova Behavioral Health2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

732 Beckman St
Dayton, OH 45410
Phone (937) 253-1680

Practitioners & affiliated clinicians

Practitioners 202

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 202

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1337904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337904000000",
    "number": "1164782017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "732 BECKMAN ST",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454102165",
            "telephone_number": "937-253-1680",
            "fax_number": "937-253-8990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "732 BECKMAN ST",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454102165",
            "telephone_number": "937-253-1680",
            "fax_number": "937-253-8990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVA BEHAVIORAL HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-25",
        "last_updated": "2012-05-25",
        "status": "A",
        "authorized_official_last_name": "GORIS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "937-253-1680",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MS, LSW, LPCC-SC"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "OH",
            "license": "10-2063",
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "OH",
            "license": "1407",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2942632",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nova House Association, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Dayton, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.