Provider Demographics
NPI:1538862164
Name:NOVA PREMIYM CARE LLC
Entity type:Organization
Organization Name:NOVA PREMIYM CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-213-7321
Mailing Address - Street 1:10696 OAKTON RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-1642
Mailing Address - Country:US
Mailing Address - Phone:571-213-7321
Mailing Address - Fax:
Practice Address - Street 1:10696 OAKTON RIDGE CT
Practice Address - Street 2:
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-1642
Practice Address - Country:US
Practice Address - Phone:571-213-7321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care