MEDICARE: NOAH HEALTHCARE, 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	251E00000X	Home Health Agency	009024	TX

General Provider Information

NPI Number	:	1952689002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOAH HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	2008 E RANDOL MILL RD
Second Line	:	SUITE #113
City	:	ARLINGTON
State	:	TX
Zip	:	76011-8205
Country	:	US
Telephone Number	:	817-274-1517
Fax Number	:

Provider Business Practice Location Address
First Line	:	2008 E RANDOL MILL RD
Second Line	:	SUITE #113
City	:	ARLINGTON
State	:	TX
Zip	:	76011-8205
Country	:	US
Telephone Number	:	817-274-1517
Fax Number	:

Authorized Official
Title or Position	:	ASST. ADMINISTRATOR
Name	:	MS. CORINE OSUKOYA
Credential	:
Telephone Number	:	817-274-1517

Provider Enumeration Date	:	07/22/2011
Last Update Date	:	07/22/2011

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