Provider Demographics
NPI:1295162634
Name:MBB HOME HEALTH CARE PROVIDERS INC
Entity type:Organization
Organization Name:MBB HOME HEALTH CARE PROVIDERS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVILES
Authorized Official - Suffix:
Authorized Official - Credentials:MA, HHA
Authorized Official - Phone:561-752-6320
Mailing Address - Street 1:418 W BLOXHAM ST
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-3187
Mailing Address - Country:US
Mailing Address - Phone:561-752-6320
Mailing Address - Fax:561-732-1237
Practice Address - Street 1:418 W BLOXHAM ST
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-3187
Practice Address - Country:US
Practice Address - Phone:561-752-6320
Practice Address - Fax:561-732-1237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL232581251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health