Provider Demographics
NPI:1508212267
Name:NOBLE HORIZON OF NEVADA
Entity Type:Organization
Organization Name:NOBLE HORIZON OF NEVADA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:BLAISE
Authorized Official - Last Name:NGATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-501-5050
Mailing Address - Street 1:390 FREEPORT BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-6259
Mailing Address - Country:US
Mailing Address - Phone:775-501-5050
Mailing Address - Fax:775-501-5050
Practice Address - Street 1:390 FREEPORT BLVD STE 3
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-6259
Practice Address - Country:US
Practice Address - Phone:775-501-5050
Practice Address - Fax:775-501-5050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV9005040298Medicaid