Organization
PROVIDENCE NOBLE CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PROVIDENTIA NJIDEKA IGBOELUSI MBA (PRESIDENT)
(239) 368-2507
Entity
Organization
Contact information
Practice address
2606 64TH ST W, LEHIGH ACRES, FL 33971-0859
(239) 368-2507
(239) 368-2507
Mailing address
2606 64TH ST W, LEHIGH ACRES, FL 33971-0859
(239) 368-2507
(239) 368-2507
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
089327
FL
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
089327
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
688753801
—
FL
05
—
688753896
—
FL
Enumeration date
01/14/2011
Last updated
01/14/2011
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