1730607607 NPI number — MBA IN-HOME SERVICES LLC

Table of content: (NPI 1730607607)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730607607 NPI number — MBA IN-HOME SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MBA IN-HOME SERVICES 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:
Provider Other Organization Name Type Code:
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:
1730607607
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1386
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIKESTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63801-1386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-481-1088
Provider Business Mailing Address Fax Number:
573-355-5925

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
613 DAVIS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIKESTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63801-1958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-481-1088
Provider Business Practice Location Address Fax Number:
573-355-5925
Provider Enumeration Date:
08/31/2017

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
RHONDA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER/DIRECTOR
Authorized Official Telephone Number:
573-481-1088

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 302F00000X , with the licence number: 6448 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 23454555 . This is a "MISSOURI" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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