Provider Demographics
NPI:1720265150
Name:MB HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:MB HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAKARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANDALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-722-0040
Mailing Address - Street 1:25880, ORCHARDLAKE ROAD, STE L 12
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-1269
Mailing Address - Country:US
Mailing Address - Phone:248-442-7500
Mailing Address - Fax:248-442-7590
Practice Address - Street 1:30300 NORTHWESTERN HWY STE 220
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3228
Practice Address - Country:US
Practice Address - Phone:248-442-7500
Practice Address - Fax:248-442-7590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI237782Medicare Oscar/Certification