Provider Demographics
NPI:1720722549
Name:NOBILITY BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:NOBILITY BEHAVIORAL HEALTH LLC
Other - Org Name:NOBILITY BETTER HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:TED
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-317-3353
Mailing Address - Street 1:9075 STONEY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-7242
Mailing Address - Country:US
Mailing Address - Phone:208-317-3353
Mailing Address - Fax:
Practice Address - Street 1:415 N 3RD AVE STE B
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-6306
Practice Address - Country:US
Practice Address - Phone:208-646-4165
Practice Address - Fax:208-646-4195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-27
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty