Healthcare Provider Details

I. General information

NPI: 1750859229
Provider Name (Legal Business Name): THE NOBLE HOME II, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2018
Last Update Date: 11/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 E GRAND BLVD
DETROIT MI
48207-3616
US

IV. Provider business mailing address

19620 CHERRYLAWN ST
DETROIT MI
48221-1606
US

V. Phone/Fax

Practice location:
  • Phone: 313-922-4164
  • Fax: 313-736-3781
Mailing address:
  • Phone: 313-477-0461
  • Fax: 313-736-3781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

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