Provider Demographics
NPI:1477595940
Name:MB CARE LLC
Entity Type:Organization
Organization Name:MB CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SAGRARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MIMBELA
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:915-269-5365
Mailing Address - Street 1:409 EXECUTIVE CENTER BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-1020
Mailing Address - Country:US
Mailing Address - Phone:915-269-5365
Mailing Address - Fax:915-581-2485
Practice Address - Street 1:409 EXECUTIVE CENTER BLVD STE 200
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1020
Practice Address - Country:US
Practice Address - Phone:915-269-5365
Practice Address - Fax:915-581-2485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009463251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178513101Medicaid