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NPI Code Detail

MEDICARE: BRENT NOBLES PRS

MEDICARE: BRENT NOBLES PRS
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
1251S00000XCommunity/Behavioral Health AgencyCDCA.169978OH
2175T00000XPeer Specialist006748OH

General Provider Information

NPI Number : 1316409360
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENT NOBLES PRS
Provider Business Mailing Address
First Line : 1356 W 85TH ST APT 1
Second Line :
City : CLEVELAND
State : OH
Zip : 44102-1878
Country : US
Telephone Number : 567-242-3352
Fax Number :
Provider Business Practice Location Address
First Line : 4705 STATE RD
Second Line :
City : CLEVELAND
State : OH
Zip : 44109-5244
Country : US
Telephone Number : 440-468-6550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2019
Last Update Date : 12/02/2025

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Directions to “ BRENT NOBLES PRS” Practice Location

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