Provider Demographics
NPI:1619543642
Name:MISBAH HOME CARE AGENCY LLC
Entity Type:Organization
Organization Name:MISBAH HOME CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-745-0902
Mailing Address - Street 1:208 E PETTIT AVE STE 59
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46806-0001
Mailing Address - Country:US
Mailing Address - Phone:260-443-9698
Mailing Address - Fax:
Practice Address - Street 1:727 E PAULDING RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46816-1287
Practice Address - Country:US
Practice Address - Phone:260-745-0902
Practice Address - Fax:260-745-0902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-01
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care