Provider Demographics
NPI:1174240204
Name:NOVA CARE CENTER LLC
Entity type:Organization
Organization Name:NOVA CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AYAN
Authorized Official - Middle Name:ABDI
Authorized Official - Last Name:MAHAMUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-964-0142
Mailing Address - Street 1:8673 COLUMBINE RD
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7668
Mailing Address - Country:US
Mailing Address - Phone:612-964-0142
Mailing Address - Fax:
Practice Address - Street 1:8673 COLUMBINE RD
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7668
Practice Address - Country:US
Practice Address - Phone:612-964-0142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOVA CARE CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-19
Last Update Date:2023-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty