Provider Demographics
NPI:1295395549
Name:MIRAGE HOME HEALTH LLC
Entity Type:Organization
Organization Name:MIRAGE HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:A
Authorized Official - Last Name:MABBAYAD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:760-799-4025
Mailing Address - Street 1:2145 E TAHQUITZ CANYON WAY STE 3
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7020
Mailing Address - Country:US
Mailing Address - Phone:760-322-3700
Mailing Address - Fax:760-322-3710
Practice Address - Street 1:2145 E TAHQUITZ CANYON WAY STE 3
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7020
Practice Address - Country:US
Practice Address - Phone:760-322-3700
Practice Address - Fax:760-322-3710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health