Provider Demographics
NPI:1669113056
Name:MOBO JV LLC
Entity type:Organization
Organization Name:MOBO JV LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SYSTEMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LACLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-660-6029
Mailing Address - Street 1:257 TURNPIKE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-1791
Mailing Address - Country:US
Mailing Address - Phone:508-281-6464
Mailing Address - Fax:
Practice Address - Street 1:1629 SMIRL DR STE 101
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:TX
Practice Address - Zip Code:75032-7624
Practice Address - Country:US
Practice Address - Phone:972-433-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-07
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental