Provider Demographics
NPI:1619336716
Name:MBI
Entity Type:Organization
Organization Name:MBI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOME HEALTH AID
Authorized Official - Prefix:MISS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:EBANGHA
Authorized Official - Last Name:TAMBE
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:240-898-8768
Mailing Address - Street 1:4609 30TH STREET
Mailing Address - Street 2:4609
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712
Mailing Address - Country:US
Mailing Address - Phone:240-898-8768
Mailing Address - Fax:
Practice Address - Street 1:4609 30TH ST
Practice Address - Street 2:4609
Practice Address - City:MOUNT RAINIER
Practice Address - State:MD
Practice Address - Zip Code:20712-1316
Practice Address - Country:US
Practice Address - Phone:240-898-8768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHHA11745251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health