MEDICARE: NOBLE 12 BUSINESS SOLLUTIONS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1104691930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOBLE 12 BUSINESS SOLLUTIONS LLC

Provider Business Mailing Address
First Line	:	PO BOX 464
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85380-0464
Country	:	US
Telephone Number	:	800-793-4656
Fax Number	:	800-793-4656

Provider Business Practice Location Address
First Line	:	9100 N CENTRAL AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-2430
Country	:	US
Telephone Number	:	800-793-4656
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	BRANDI CAUDELL
Credential	:
Telephone Number	:	800-793-4656

Provider Enumeration Date	:	11/21/2023
Last Update Date	:	11/21/2023

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Directions to “NOBLE 12 BUSINESS SOLLUTIONS LLC ” Practice Location

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