Nova Inc

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

0100408 Issued in CA

Legal business name

NOVA INC

Practice address

393 Nova Albion Way
San Rafael, CA 94903-3607

Phone

(415) 472-2373

Fax

(415) 472-5739

NPI assigned

May 19, 2008

Organization subpart

Yes

Parent organization

MARIN ASSOC FOR RETARDED CITIZENS (LIFEHOUSE)As reported in NPPES

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

Authorized official

Name

Merlyn Teague

Title

Director of Admin/Finacial

Phone

(415) 472-2373

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 05G789

Legal name

NOVA HOUSE, INC

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Dec 14, 1993

Last certification

Oct 17, 2024

Beds

6

Ownership / control type

Private (non-profit)

Facility address

393 Nova Albion Way
San Rafael, CA 94903

Tax ID family

Big R Respite Home5 organizations share this tax ID, including this one

Part of

Big R Respite Home

Other organizations with this tax ID 4

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

• Lifehouse Ine

  • Intellectual Disabilities Intermediate Care Facility
  • San Rafael, CA
  • NPI 1528240785
  NPD tax ID
• Stonehave

  • Intellectual Disabilities Intermediate Care Facility
  • Novato, CA
  • NPI 1770740623
  NPD tax ID
• Sunrise I

  • Intellectual Disabilities Intermediate Care Facility
  • Novato, CA
  • NPI 1891952719
  NPD tax ID
• Sunrise II

  • Intellectual Disabilities Intermediate Care Facility
  • San Rafael, CA
  • NPI 1528225455
  NPD tax ID

Locations

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

{
    "created_epoch": "1211155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211155200000",
    "number": "1932366895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 SMITH RANCH RD",
            "address_2": "SUITE 309",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949031900",
            "telephone_number": "415-472-2373",
            "fax_number": "415-472-5739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "393 NOVA ALBION WAY",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949033607",
            "telephone_number": "415-472-2373",
            "fax_number": "415-472-5739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVA INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARIN ASSOC FOR RETARDED CITIZENS (LIFEHOUSE)",
        "enumeration_date": "2008-05-19",
        "last_updated": "2008-05-19",
        "status": "A",
        "authorized_official_last_name": "TEAGUE",
        "authorized_official_first_name": "MERLYN",
        "authorized_official_title_or_position": "DIRECTOR OF ADMIN/FINACIAL",
        "authorized_official_telephone_number": "415-472-2373"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "CA",
            "license": "0100408",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6422425",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC60509F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Northern California Uropathology PC
• Northgate Care Center, Inc.
• Northgate Postacute Care
• Gerard Fuertes Notario
• Daniel Notzon, M.D.
• Barbara Eileen Nova, PH.D.
• Kenneth E. Novich, MD
• Virginia Nowak, MS, CCC/SLP
• NP Plus, LLC
• Debra Nunes

• Intellectual Disabilities Intermediate Care Facility in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Intellectual Disabilities Intermediate Care Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.