Healthcare Provider Details

I. General information

NPI: 1821950544
Provider Name (Legal Business Name): NOBLEQUEST FOUNDATION COMMUNITY SUPPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 BEVERLY BLVD STE D
LOS ANGELES CA
90057-1033
US

IV. Provider business mailing address

3101 BEVERLY BLVD STE D
LOS ANGELES CA
90057-1033
US

V. Phone/Fax

Practice location:
  • Phone: 818-997-7117
  • Fax: 818-997-0117
Mailing address:
  • Phone: 818-997-7117
  • Fax: 818-997-0117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: CAROL CARILLO
Title or Position: ADMINISTRATOR
Credential:
Phone: 818-300-8363