Washington Street East Group Home

LBN: Nova Ic, Inc.
Washington Street East Group Home is an health care organization with primary practice located at 407 W. Washington Street , Lagrange NC 28551-1623. The organization recently has only one registered license in Nursing & Custodial Care Facilities / Intermediate Care Facility, Mentally Retarded, which is considered as the primary health care specialty. Nova Ic, Inc. can be contacted via phone (919) 734-8803, or through Pridgen, Tracey via phone (919) 734-8803.

Contact Information

Primary practice address
407 W. Washington Street Lagrange NC 28551-1623
Phone: (919) 734-8803
Fax: (919) 735-6825
Website:
Map and Directions
Authorized official contact:
Name: Pridgen, Tracey CPA
Phone: (919) 734-8803

Health care specialties

SpecialtyCodeLicense #State
Nursing & Custodial Care Facilities / Intermediate Care Facility, Mentally Retarded 315P00000X MHL-054-038 North Carolina

Profile Details

NPI number 1669611471
LBN Legal business name Nova Ic, Inc.
DBA Doing business as Washington Street East Group Home
Authorized official Pridgen, Tracey CPA
Entity Organization
Organization subpart 1 No
Enumeration date Feb 18th, 2009
Last updated Sep 29th, 2023 - about last year

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669611471 NPPES
North Carolina MEDICAID 340608V

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