=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518528181
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NOBLE HOME HEALTH SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2019
-----------------------------------------------------
Last Update Date | 04/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2309 NASSAU DR
-----------------------------------------------------
City | MCKINNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75071-1311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-636-6228
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4440 SPRING VALLEY RD
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75244-3703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-636-6228
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MR. OLANREWAJU ABU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-636-6228
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------