Organization · NPI-2
Nova Via Glendale LLC
Integrative Medicine · Glendale, AZ
NPI number1801764212
StatusActive
Last updated in NPPESOct 27, 2025
Details
- NPI
- 1801764212
- Entity type
- Organization (NPI-2)
- Legal business name
- Nova Via Glendale LLC
- Organization subpart
- No
- Enumeration date
- Oct 27, 2025
- Certification date
- Oct 27, 2025
- Last updated
- Oct 27, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 202D00000X | Integrative Medicine | – | – | Yes |
| 101YA0400X | Counselor, Addiction (Substance Use Disorder) | – | – | |
| 101YM0800X | Counselor, Mental Health | – | – | |
| 104100000X | Social Worker | – | – | |
| 106S00000X | Behavior Technician | – | – | |
| 111N00000X | Chiropractor | – | – | |
| 133N00000X | Nutritionist | – | – | |
| 163W00000X | Registered Nurse | – | – | |
| 164W00000X | Licensed Practical Nurse | – | – | |
| 207QA0401X | Family Medicine, Addiction Medicine | – | – | |
| 207QA0505X | Family Medicine, Adult Medicine | – | – | |
| 208100000X | Physical Medicine & Rehabilitation | – | – | |
| 2083A0300X | Preventive Medicine, Addiction Medicine | – | – | |
| 251B00000X | Case Management | – | – |
Practice location
6830 N 55th AveSuite 100
Glendale, AZ 85301
Phone 480-543-7432
Mailing address
6830 N 55th AveSuite 100
Glendale, AZ 85301
Phone 480-543-7432
Authorized official
Stephanie Jolly
Chief Compliance Officer
4805437432
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