Provider Demographics
NPI: | 1831870104 |
---|---|
Name: | NOBLE VISION BEHAVIOR HEALTH LLC |
Entity type: | Organization |
Organization Name: | NOBLE VISION BEHAVIOR HEALTH LLC |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | LANCE |
Authorized Official - Middle Name: | D |
Authorized Official - Last Name: | SULLIVAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 614-439-0908 |
Mailing Address - Street 1: | 1495 MORSE RD STE B7 |
Mailing Address - Street 2: | |
Mailing Address - City: | COLUMBUS |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 43229-6434 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 614-439-0908 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1495 MORSE RD STE B7 |
Practice Address - Street 2: | |
Practice Address - City: | COLUMBUS |
Practice Address - State: | OH |
Practice Address - Zip Code: | 43229-6434 |
Practice Address - Country: | US |
Practice Address - Phone: | 614-439-0908 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2023-07-28 |
Last Update Date: | 2025-05-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 322D00000X | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | ||
No | 323P00000X | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | ||
No | 3245S0500X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children | |
No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | |
No | 261QR0401X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | |
No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | |
No | 273R00000X | Hospital Units | Psychiatric Unit | ||
No | 385H00000X | Respite Care Facility | Respite Care | Group - Single Specialty | |
No | 405300000X | Other Service Providers | Prevention Professional | Group - Single Specialty |