| Club Nova Community, Inc | |
|
103 W Main St Suite D Carrboro NC 27510-2072 | |
| (919) 968-6682 | |
| (919) 968-1764 |
| Full Name | Club Nova Community, Inc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 103 W Main St, Carrboro, North Carolina |
| Authorized Official Name and Position | Jacob Long (ASSOCIATE DIRECTOR OF ADMINISTRATIO) |
| Authorized Official Contact | 9199686682 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Club Nova Community, Inc 103 W Main St Suite D Carrboro NC 27510-2072 Ph: (919) 968-6682 | Club Nova Community, Inc 103 W Main St Suite D Carrboro NC 27510-2072 Ph: (919) 968-6682 |
| NPI Number | 1639232044 |
|---|---|
| Provider Enumeration Date | 12/18/2006 |
| Last Update Date | 09/14/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639232044 | NPI | - | NPPES |
| 8301156S | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | MHL068017 (North Carolina) | Primary |
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