Healthcare Provider Details

I. General information

NPI: 1891133781
Provider Name (Legal Business Name): NOCERA ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 MANCHESTER DR
SOUTH BEND IN
46615-3836
US

IV. Provider business mailing address

1321 MANCHESTER DR
SOUTH BEND IN
46615-3836
US

V. Phone/Fax

Practice location:
  • Phone: 574-232-5532
  • Fax:
Mailing address:
  • Phone: 574-232-5532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ROCCO LEOPOLD NOCERA
Title or Position: MANAGING MEMBER
Credential: MA, BCBA
Phone: 574-232-5532