MEDICARE: NOBLE CARES 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	163WH0200X	Home Health Registered Nurse

General Provider Information

NPI Number	:	1629729728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOBLE CARES LLC

Provider Business Mailing Address
First Line	:	2409 132ND AVE NW
Second Line	:
City	:	COON RAPIDS
State	:	MN
Zip	:	55448-2567
Country	:	US
Telephone Number	:	612-978-0574
Fax Number	:

Provider Business Practice Location Address
First Line	:	7957 MONROE ST NE
Second Line	:
City	:	SPRING LAKE PARK
State	:	MN
Zip	:	55432-1968
Country	:	US
Telephone Number	:	612-978-0574
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED NURSE
Name	:	EBENEZER AKINBAMIJO
Credential	:
Telephone Number	:	612-978-0574

Provider Enumeration Date	:	01/11/2022
Last Update Date	:	01/11/2022

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Directions to “NOBLE CARES LLC ” Practice Location

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