Mba In-Home Service LLC
Exclusive Provider Organization in Sikeston, MO. Organization (NPI-2).
NPI number1548776131
StatusActive
Last updated in NPPESDec 19, 2017
Details
- NPI
- 1548776131
- Entity type
- Organization (NPI-2)
- Legal business name
- Mba In-Home Service LLC
- Organization subpart
- No
- Enumeration date
- Dec 19, 2017
- Last updated
- Dec 19, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 302F00000X | Exclusive Provider Organization | 6448 | MO | Yes |
Practice location
1217 W Malone AveSikeston, MO 63801
Phone 573-481-1088 · Fax 573-475-8774
Mailing address
Po Box 1386Sikeston, MO 63801-1386
Phone 573-481-1088 · Fax 573-475-8774
Authorized official
Rhonda L Williams
Director/Owner
5734811088
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