=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013215409
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NOBLE CARELLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2011
-----------------------------------------------------
Last Update Date | 11/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 507 WASHINGTON AVE
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23851-1556
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-303-5846
-----------------------------------------------------
Fax | 757-538-0064
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 225 HOLBROOK ARCH
-----------------------------------------------------
City | SUFFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23434-2157
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-303-5846
-----------------------------------------------------
Fax | 757-538-0064
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROGRAM DIRECTOR
-----------------------------------------------------
Name | MRS. JACQUELINE A MYRICK
-----------------------------------------------------
Credential | BACHELORS DEGREE I
-----------------------------------------------------
Telephone | 757-303-5846
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 385H00000X
-----------------------------------------------------
Taxonomy Name | Respite Care
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number | 1602-01-001
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3747P1801X
-----------------------------------------------------
Taxonomy Name | Personal Care Attendant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 320900000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
-----------------------------------------------------
License Number | 1602-01-001
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------