Avita Nova

Key facts

NPI

1780937235

Entity type

Organization (NPI type 2)

Primary specialty

Community/Behavioral Health Agency 251S00000X

Legal business name

AVITA NOVA

Practice address

1202 Bellecour Way
Lake Forest, CA 92630-7944

Phone

(949) 939-8032

Fax

(949) 525-4759

NPI assigned

Oct 22, 2012

Organization subpart

No

Authorized official

Name

Erica R. Holding, PH.D., BCBA

Title

Owner

Phone

(949) 939-8032

National Provider Directory

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 22, 2012.

{
    "created_epoch": "1350864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350864000000",
    "number": "1780937235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 BELLECOUR WAY",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926307944",
            "telephone_number": "949-939-8032",
            "fax_number": "949-525-4759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 BELLECOUR WAY",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926307944",
            "telephone_number": "949-939-8032",
            "fax_number": "949-525-4759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVITA NOVA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-22",
        "last_updated": "2012-10-22",
        "status": "A",
        "authorized_official_last_name": "HOLDING",
        "authorized_official_first_name": "ERICA",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "949-939-8032",
        "authorized_official_credential": "PH.D., BCBA"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Lake Forest, CA · Community/Behavioral Health Agency in California