MEDICARE: NOBLEQUEST FOUNDATION COMMUNITY SUPPORT 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	385H00000X	Respite Care
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1821950544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOBLEQUEST FOUNDATION COMMUNITY SUPPORT LLC

Provider Business Mailing Address
First Line	:	3101 BEVERLY BLVD STE D
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-1033
Country	:	US
Telephone Number	:	818-997-7117
Fax Number	:	818-997-0117

Provider Business Practice Location Address
First Line	:	3101 BEVERLY BLVD STE D
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-1033
Country	:	US
Telephone Number	:	818-997-7117
Fax Number	:	818-997-0117

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	CAROL CARILLO
Credential	:
Telephone Number	:	818-300-8363

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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