Provider Demographics
NPI:1528546298
Name:ENNOBLE NURSING LLC
Entity Type:Organization
Organization Name:ENNOBLE NURSING LLC
Other - Org Name:ENNOBLE NURSING AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:KIBEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-564-9339
Mailing Address - Street 1:2000 PASADENA DR
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-0808
Mailing Address - Country:US
Mailing Address - Phone:563-577-1076
Mailing Address - Fax:
Practice Address - Street 1:2000 PASADENA DR
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-0808
Practice Address - Country:US
Practice Address - Phone:563-577-1076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility