1912309485 NPI number — NOBLE HEALTH CARE INC

Table of content: (NPI 1912309485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912309485 NPI number — NOBLE HEALTH CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NOBLE HEALTH CARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GOLDEN PLAINS CARE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912309485
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1801 MORROW LANAE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABILENE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79601-2607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-338-2385
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
605 W 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POST
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79356-3141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-495-2848
Provider Business Practice Location Address Fax Number:
806-495-3976
Provider Enumeration Date:
09/16/2014

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
STORMIE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
325-338-2385

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0000000 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 005165 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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