Provider Demographics
NPI:1932470390
Name:MABEL CUSTODY SERVICES INC.
Entity Type:Organization
Organization Name:MABEL CUSTODY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DUENA
Authorized Official - Prefix:
Authorized Official - First Name:JOHANA
Authorized Official - Middle Name:IVETTE
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:RN - ENFERMEN GREDUO
Authorized Official - Phone:939-247-4326
Mailing Address - Street 1:P.O. BOX 126
Mailing Address - Street 2:
Mailing Address - City:ENSENADA
Mailing Address - State:PR
Mailing Address - Zip Code:00647
Mailing Address - Country:US
Mailing Address - Phone:939-247-4326
Mailing Address - Fax:
Practice Address - Street 1:60 CALLE ROBERTO CLEMENTE
Practice Address - Street 2:BO. MONTALVA
Practice Address - City:ENSENADA
Practice Address - State:PR
Practice Address - Zip Code:00647-1321
Practice Address - Country:US
Practice Address - Phone:939-247-4326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-17
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care