Provider Demographics
NPI:1184341919
Name:BBI NOVACARE LLC
Entity type:Organization
Organization Name:BBI NOVACARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:
Authorized Official - Last Name:UBANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-419-0975
Mailing Address - Street 1:1503 S US HIGHWAY 301 STE 93
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-5126
Mailing Address - Country:US
Mailing Address - Phone:813-419-0975
Mailing Address - Fax:
Practice Address - Street 1:1503 S US HIGHWAY 301 STE 93
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-5126
Practice Address - Country:US
Practice Address - Phone:813-419-0975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10D2263528Medicaid