Provider Demographics
NPI:1952689002
Name:NOAH HEALTHCARE, LLC
Entity Type:Organization
Organization Name:NOAH HEALTHCARE, LLC
Other - Org Name:FOUNTAIN HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASST. ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CORINE
Authorized Official - Middle Name:
Authorized Official - Last Name:OSUKOYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-274-1517
Mailing Address - Street 1:2008 E RANDOL MILL RD
Mailing Address - Street 2:SUITE #113
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-8205
Mailing Address - Country:US
Mailing Address - Phone:817-274-1517
Mailing Address - Fax:
Practice Address - Street 1:2008 E RANDOL MILL RD
Practice Address - Street 2:SUITE #113
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-8205
Practice Address - Country:US
Practice Address - Phone:817-274-1517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009024251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health