Provider Demographics
NPI:1871291062
Name:THE NOVA RESIDENCE INC
Entity type:Organization
Organization Name:THE NOVA RESIDENCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-806-7409
Mailing Address - Street 1:148 BLUE LAKES BLVD N # 193
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5235
Mailing Address - Country:US
Mailing Address - Phone:208-948-0476
Mailing Address - Fax:
Practice Address - Street 1:527 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3822
Practice Address - Country:US
Practice Address - Phone:208-948-0476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging