Provider Demographics
NPI:1679982524
Name:NOBLE SUB-ACUTE CARE SERVICES, INC.
Entity Type:Organization
Organization Name:NOBLE SUB-ACUTE CARE SERVICES, INC.
Other - Org Name:MOCHO PARK CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:STAMM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:925-447-2280
Mailing Address - Street 1:125 SILVER OAK TER
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-1226
Mailing Address - Country:US
Mailing Address - Phone:925-447-2280
Mailing Address - Fax:925-454-5335
Practice Address - Street 1:752 HOLMES ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4229
Practice Address - Country:US
Practice Address - Phone:925-447-2280
Practice Address - Fax:925-454-5335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550003515314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1679982524Medicaid
CA555899Medicare PIN