Provider Demographics
NPI:1326775628
Name:TEBOH'S INFINITE CARE LLC
Entity Type:Organization
Organization Name:TEBOH'S INFINITE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:TEBOH
Authorized Official - Last Name:MBATANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-650-7354
Mailing Address - Street 1:35913 W CARTEGNA LN
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-2172
Mailing Address - Country:US
Mailing Address - Phone:575-650-7354
Mailing Address - Fax:
Practice Address - Street 1:35913 W CARTEGNA LN
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-2172
Practice Address - Country:US
Practice Address - Phone:575-650-7354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances