Provider Demographics
NPI:1295278026
Name:NOAH RESIDENTIAL CARE SERVICES, LLC
Entity type:Organization
Organization Name:NOAH RESIDENTIAL CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADETOKUNBO
Authorized Official - Middle Name:O
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-442-9268
Mailing Address - Street 1:3810 HARLAN DR
Mailing Address - Street 2:
Mailing Address - City:SACHSE
Mailing Address - State:TX
Mailing Address - Zip Code:75048-1912
Mailing Address - Country:US
Mailing Address - Phone:972-442-9268
Mailing Address - Fax:
Practice Address - Street 1:3810 HARLAN DR
Practice Address - Street 2:
Practice Address - City:SACHSE
Practice Address - State:TX
Practice Address - Zip Code:75048-1912
Practice Address - Country:US
Practice Address - Phone:972-442-9268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX302F00000X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No302F00000XManaged Care OrganizationsExclusive Provider Organization