Healthcare Provider Details

I. General information

NPI: 1770103822
Provider Name (Legal Business Name): NOBLE HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2020
Last Update Date: 04/19/2020
Certification Date: 04/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40353 N PARISI PL
SAN TAN VALLEY AZ
85140-6825
US

IV. Provider business mailing address

1342 W PARK AVE
CHANDLER AZ
85224-8663
US

V. Phone/Fax

Practice location:
  • Phone: 480-508-1447
  • Fax: 480-508-1448
Mailing address:
  • Phone: 646-944-9582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. NUREIN SHAIBU
Title or Position: ADMINISTRATOR
Credential:
Phone: 646-944-9582