Provider Demographics
NPI:1679931349
Name:NOVUS ADULT CARE SERVICES INC.
Entity type:Organization
Organization Name:NOVUS ADULT CARE SERVICES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:III
Authorized Official - Credentials:CRNP
Authorized Official - Phone:610-867-5365
Mailing Address - Street 1:1565 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-4744
Mailing Address - Country:US
Mailing Address - Phone:610-867-5365
Mailing Address - Fax:610-867-5366
Practice Address - Street 1:1565 LINDEN ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-4744
Practice Address - Country:US
Practice Address - Phone:610-867-5365
Practice Address - Fax:610-867-5366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010690363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103060981Medicaid