Provider Demographics
NPI:1750834719
Name:IAATK INC
Entity Type:Organization
Organization Name:IAATK INC
Other - Org Name:SUPERIOR HOME HEALH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:SANDOVAL
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-737-4357
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93438-0001
Mailing Address - Country:US
Mailing Address - Phone:805-737-4357
Mailing Address - Fax:805-735-2410
Practice Address - Street 1:320 E WALNUT AVE
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-6835
Practice Address - Country:US
Practice Address - Phone:805-737-4357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
CA424700001253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care