Provider Demographics
NPI:1447078795
Name:NOVARA RECOVERY CENTER VIRGINIA DRUG & ALCOHOL REHAB
Entity type:Organization
Organization Name:NOVARA RECOVERY CENTER VIRGINIA DRUG & ALCOHOL REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RYLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-297-9909
Mailing Address - Street 1:2815 OLD LEE HWY FL 2
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4303
Mailing Address - Country:US
Mailing Address - Phone:703-705-7870
Mailing Address - Fax:862-209-2213
Practice Address - Street 1:2815 OLD LEE HWY FL 2
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4303
Practice Address - Country:US
Practice Address - Phone:703-705-7870
Practice Address - Fax:862-209-2213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-26
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA12453OtherCOMMONWEALTH OF VIRGINIA