Healthcare Provider Details

I. General information

NPI: 1013215409
Provider Name (Legal Business Name): NOBLE CARELLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2011
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 WASHINGTON AVE
FRANKLIN VA
23851-1556
US

IV. Provider business mailing address

225 HOLBROOK ARCH
SUFFOLK VA
23434-2157
US

V. Phone/Fax

Practice location:
  • Phone: 757-303-5846
  • Fax: 757-538-0064
Mailing address:
  • Phone: 757-303-5846
  • Fax: 757-538-0064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number1602-01-001
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number1602-01-001
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. JACQUELINE A MYRICK
Title or Position: PROGRAM DIRECTOR
Credential: BACHELORS DEGREE I
Phone: 757-303-5846