Provider Demographics
NPI:1528412061
Name:KABAMEDICALCORPORATION
Entity Type:Organization
Organization Name:KABAMEDICALCORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LASANA
Authorized Official - Middle Name:B
Authorized Official - Last Name:KABA
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:978-278-5472
Mailing Address - Street 1:484 LOWELL ST STE 1B-1
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-7928
Mailing Address - Country:US
Mailing Address - Phone:978-278-5472
Mailing Address - Fax:978-817-2991
Practice Address - Street 1:484LOWELL STREET
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960
Practice Address - Country:US
Practice Address - Phone:978-278-5472
Practice Address - Fax:978-817-2991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA00121624332BN1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies