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NPI Code Detail

MEDICARE: WALT NOBLE INC.

MEDICARE: WALT NOBLE INC.
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
1310400000XAssisted Living FacilityAL 5944FL

General Provider Information

NPI Number : 1891130787
Entity Type Code : Organization
Provider Name (Legal Business Name) : WALT NOBLE INC.
Provider Business Mailing Address
First Line : 5121 NE 19TH AVE
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33308-3712
Country : US
Telephone Number : 954-491-4041
Fax Number : 954-772-4657
Provider Business Practice Location Address
First Line : 5121 NE 19TH AVE
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33308-3712
Country : US
Telephone Number : 954-491-4041
Fax Number : 954-772-4657
Authorized Official
Title or Position : ADMINISTRATOR
Name : EUSEBIO C NOBLEFRANCA
Credential :
Telephone Number : 954-491-4041
Provider Enumeration Date : 05/06/2013
Last Update Date : 05/06/2013

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