NPIMap

Organization Active NPI

Nova Ic, Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Goldsboro, NC
National Provider Identifier
1699914598
Registry record updated Sep 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
MHL-096-110 Issued in NC
Legal business name
NOVA IC, INC.
Practice address
2510 Norwood Ave
Goldsboro, NC 27534-1671
Phone
(919) 734-8803
Fax
(919) 735-6825
NPI assigned
Feb 17, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2026

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X MHL-096-110 NC Primary

Addresses

Primary practice location

2510 Norwood Ave
Goldsboro, NC 27534-1671

Mailing address

PO Box 11077
Goldsboro, NC 27532-1077
Phone (919) 734-8803

Other identifiers 1

IdentifierTypeStateIssuer
340610MMedicaidNC

Other names 1

  • Norwood Avenue Home Other name

National Provider Directory

National Provider Directory
Tax ID family
Nova Ic Inc18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1234828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790121600000",
    "number": "1699914598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11077",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275321077",
            "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": "2510 NORWOOD AVE",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275341671",
            "telephone_number": "919-734-8803",
            "fax_number": "919-735-6825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVA IC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-17",
        "last_updated": "2026-09-23",
        "certification_date": "2026-09-23",
        "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": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NC",
            "license": "MHL-096-110",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "340610M",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Norwood Avenue Home",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Norwood Avenue Home",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Goldsboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2026; 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.