Providence Noble Care Inc

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

089327 Issued in FL

Legal business name

PROVIDENCE NOBLE CARE INC

Practice address

2606 64TH St W
Lehigh Acres, FL 33971-0859

Phone

(239) 368-2507

Fax

(239) 368-2507

NPI assigned

Jan 14, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Providentia Njideka Igboelusi, MBA

Title

President

Phone

(239) 368-2507

Specialties & licenses 2

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1294963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294963200000",
    "number": "1902101488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2606 64TH ST W",
            "city": "LEHIGH ACRES",
            "state": "FL",
            "postal_code": "339710859",
            "telephone_number": "239-368-2507",
            "fax_number": "239-368-2507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2606 64TH ST W",
            "city": "LEHIGH ACRES",
            "state": "FL",
            "postal_code": "339710859",
            "telephone_number": "239-368-2507",
            "fax_number": "239-368-2507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE NOBLE CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-14",
        "last_updated": "2011-01-14",
        "status": "A",
        "authorized_official_last_name": "IGBOELUSI",
        "authorized_official_first_name": "PROVIDENTIA",
        "authorized_official_middle_name": "NJIDEKA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "239-368-2507",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "FL",
            "license": "089327",
            "primary": true
        },
        {
            "code": "385HR2060X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
            "state": "FL",
            "license": "089327",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "688753896",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "688753801",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Lehigh Acres, FL
• Providers in Lehigh Acres, FL by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.