Provider Demographics
NPI:1467861955
Name:IBE, HENRY
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:IBE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-7010
Mailing Address - Country:US
Mailing Address - Phone:978-685-4700
Mailing Address - Fax:978-685-4701
Practice Address - Street 1:147 PELHAM ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-2060
Practice Address - Country:US
Practice Address - Phone:978-685-4700
Practice Address - Fax:978-685-4701
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide