1922372390 NPI number — NOBLE CARE CORP.

Table of content: (NPI 1922372390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922372390 NPI number — NOBLE CARE CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NOBLE CARE CORP.
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:
Provider Other Organization Name Type Code:
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:
1922372390
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
140 S CAMINO SECO
Provider Second Line Business Mailing Address:
SUITE 305
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85710-4484
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-398-5675
Provider Business Mailing Address Fax Number:
520-398-5887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3711 S CINDY LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85730-4444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-344-7260
Provider Business Practice Location Address Fax Number:
520-344-7260
Provider Enumeration Date:
03/02/2012

Additional Information

Authorized Official

Authorized Official Last Name:
WALLEN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
520-331-3642

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 983553 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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