Nova Care Center LLC

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

Legal business name

NOVA CARE CENTER LLC

Practice address

8673 Columbine Rd
Eden Prairie, MN 55344-7668

Phone

(612) 964-0142

NPI assigned

Oct 19, 2022

Last updated

Apr 29, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

NOVA CARE CENTER LLCAs reported in NPPES

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

Authorized official

Name

Ayan Abdi Mahamud

Title

Executive Director

Phone

(612) 964-0142

Specialties & licenses 1

Addresses

Part of

Nova Care Center LLC

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Abdihakin Mohamud

  • Behavior Technician
  • Eden Prairie, MN
  • NPI 1578255071
  NPD

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

{
    "created_epoch": "1666137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682726400000",
    "number": "1174240204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8673 COLUMBINE RD",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553447668",
            "telephone_number": "612-964-0142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8673 COLUMBINE RD",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553447668",
            "telephone_number": "612-964-0142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVA CARE CENTER LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NOVA CARE CENTER LLC",
        "enumeration_date": "2022-10-19",
        "last_updated": "2023-04-29",
        "certification_date": "2023-04-29",
        "status": "A",
        "authorized_official_last_name": "MAHAMUD",
        "authorized_official_first_name": "AYAN",
        "authorized_official_middle_name": "ABDI",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "612-964-0142"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Early Intervention Provider Agency in Eden Prairie, MN
• Providers in Eden Prairie, MN by specialty
• Early Intervention Provider Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2023; 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.