Provider Demographics
NPI:1992825327
Name:NOIR ENTERPRISES, LLC
Entity Type:Organization
Organization Name:NOIR ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GALE
Authorized Official - Middle Name:O
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-654-9452
Mailing Address - Street 1:5030 HENDERSONVILLE RD.
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-6694
Mailing Address - Country:US
Mailing Address - Phone:828-645-9452
Mailing Address - Fax:
Practice Address - Street 1:5030 HENDERSONVILLE RD
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:NC
Practice Address - Zip Code:28732-6694
Practice Address - Country:US
Practice Address - Phone:828-645-9452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409644Medicaid
NC8301272Medicaid