NPIMap

Organization Active NPI

Nova Inc.

  • Psychiatric Residential Treatment Facility
  • Kinston, NC
National Provider Identifier
1407886229
Registry record updated Sep 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X
Legal business name
NOVA INC.
Practice address
2002 Shackle Ford Rd
Kinston, NC 28504-8917
Phone
(252) 233-0491
Fax
(252) 233-0495
NPI assigned
Jul 4, 2006
Last updated
Sep 27, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2024

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

Authorized official

Name
Tracey Pridgen
Title
Cfo
Phone
(919) 734-8803

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X NC
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X NHL-054-013 NC
Psychiatric Residential Treatment Facility 323P00000X Primary

Addresses

Primary practice location

2002 Shackle Ford Rd
Kinston, NC 28504-8917

Mailing address

PO Box 11147
Goldsboro, NC 27532-1147
Phone (919) 734-8803

Other identifiers 11

IdentifierTypeStateIssuer
6603000MedicaidNC
8301286DMedicaidNC
6603013MedicaidNC
6603014MedicaidNC
6603006MedicaidNC
6603011MedicaidNC
8300966MedicaidNC
8300789BMedicaidNC
6005810MedicaidNC
8300789HMedicaidNC
6603010MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Nova Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

2002 Shackle Ford Rd
Kinston, NC 28504
Phone (252) 233-0491

NPI Registry JSON

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727395200000",
    "number": "1407886229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11147",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275321147",
            "telephone_number": "919-734-8803",
            "fax_number": "919-735-6825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2002 SHACKLE FORD RD",
            "city": "KINSTON",
            "state": "NC",
            "postal_code": "285048917",
            "telephone_number": "252-233-0491",
            "fax_number": "252-233-0495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVA INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-27",
        "status": "A",
        "authorized_official_last_name": "PRIDGEN",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "919-734-8803"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "NHL-054-013",
            "primary": false
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603000",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301286D",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603013",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603014",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603006",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603011",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300966",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300789B",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6005810",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300789H",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603010",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kinston, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2024; 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.