Provider Demographics
NPI:1831957075
Name:ANTINIQUE M NOBLE
Entity type:Organization
Organization Name:ANTINIQUE M NOBLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTINIQUE
Authorized Official - Middle Name:M
Authorized Official - Last Name:NOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-377-3307
Mailing Address - Street 1:3792 BARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-3921
Mailing Address - Country:US
Mailing Address - Phone:609-377-3307
Mailing Address - Fax:
Practice Address - Street 1:3792 BARKWOOD DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-3921
Practice Address - Country:US
Practice Address - Phone:609-377-3307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No172A00000XOther Service ProvidersDriverGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No251K00000XAgenciesPublic Health or Welfare
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty