1548719735 NPI number — MABUHAY LLC

Table of content: (NPI 1548719735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548719735 NPI number — MABUHAY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MABUHAY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
METRO HOME HEALTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548719735
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8400 S KYRENE ROAD
Provider Second Line Business Mailing Address:
SUITE 222
Provider Business Mailing Address City Name:
TEMPE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85284-2177
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-436-7227
Provider Business Mailing Address Fax Number:
480-436-7372

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8400 S KYRENE ROAD
Provider Second Line Business Practice Location Address:
SUITE 222
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85284-2177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-436-7227
Provider Business Practice Location Address Fax Number:
480-436-7372
Provider Enumeration Date:
09/28/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
JOANNE
Authorized Official Middle Name:
ELIZABETH
Authorized Official Title or Position:
DIRECTOR OF NURSING
Authorized Official Telephone Number:
480-436-7227

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)