Provider Demographics
NPI:1104819507
Name:NOBLE CARE INC
Entity type:Organization
Organization Name:NOBLE CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MANNY
Authorized Official - Middle Name:CLAIR
Authorized Official - Last Name:POLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-742-1692
Mailing Address - Street 1:PO BOX 2917
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-2917
Mailing Address - Country:US
Mailing Address - Phone:503-742-1692
Mailing Address - Fax:503-742-1693
Practice Address - Street 1:15140 SE 82ND DR
Practice Address - Street 2:SUITE 270
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9695
Practice Address - Country:US
Practice Address - Phone:503-742-1692
Practice Address - Fax:503-742-1693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0322-063416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR182226Medicaid
OR295445Medicaid
OR182226Medicaid
OR295445Medicaid