Healthcare Provider Details

I. General information

NPI: 1629729728
Provider Name (Legal Business Name): NOBLE CARES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2022
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7957 MONROE ST NE
SPRING LAKE PARK MN
55432-1968
US

IV. Provider business mailing address

2409 132ND AVE NW
COON RAPIDS MN
55448-2567
US

V. Phone/Fax

Practice location:
  • Phone: 612-978-0574
  • Fax:
Mailing address:
  • Phone: 612-978-0574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: EBENEZER AKINBAMIJO
Title or Position: REGISTERED NURSE
Credential:
Phone: 612-978-0574