Basic Information
| Provider Information | |||||||||
| NPI: | 1558792283 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NOBLEQUEST HEALTH FOUNDATION, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11024 BALBOA BLVD | ||||||||
| Address2: | 504 | ||||||||
| City: | GRANADA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183633000 | ||||||||
| FaxNumber: | 8888332881 | ||||||||
| Practice Location | |||||||||
| Address1: | 2105 BEVERLY BLVD | ||||||||
| Address2: | 231 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2134831726 | ||||||||
| FaxNumber: | 8888332881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2013 | ||||||||
| LastUpdateDate: | 09/16/2014 | ||||||||
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| AuthorizedOfficialLastName: | RIVERA | ||||||||
| AuthorizedOfficialFirstName: | AILENE | ||||||||
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| AuthorizedOfficialTitleorPosition: | FOUNDER | ||||||||
| AuthorizedOfficialTelephone: | 8183633066 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC1500X | N | Ambulatory Health Care Facilities | Clinic/Center | Community Health | 261QR0400X | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation | 251V00000X | Y | Agencies | Voluntary or Charitable |
No ID Information.