Healthcare Provider Details

I. General information

NPI: 1962015099
Provider Name (Legal Business Name): THE NOBLE HOME II, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 08/28/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 E GRAND BLVD
DETROIT MI
48207
US

IV. Provider business mailing address

19620 CHERRYLAWN
DETROIT MI
48221
US

V. Phone/Fax

Practice location:
  • Phone: 313-477-0461
  • Fax: 313-736-3781
Mailing address:
  • Phone: 313-477-0461
  • Fax: 313-736-3781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. SHELLY SIBERT
Title or Position: PRESIDENT
Credential:
Phone: 313-477-0461