Provider Demographics
NPI:1528741071
Name:NOBLE THERAPY CENTER, LLC
Entity type:Organization
Organization Name:NOBLE THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SULEMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JIWANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-719-9113
Mailing Address - Street 1:1724 WHITNEY ISLES DR
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-6066
Mailing Address - Country:US
Mailing Address - Phone:407-719-9113
Mailing Address - Fax:
Practice Address - Street 1:1928 BOOTHE CIR STE 1000
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-6774
Practice Address - Country:US
Practice Address - Phone:407-719-9113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-10
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty