Provider Demographics
NPI:1811350051
Name:MABAKA LLC
Entity type:Organization
Organization Name:MABAKA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMEBER
Authorized Official - Prefix:MS
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:BARO
Authorized Official - Last Name:KAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MOT, OTRL
Authorized Official - Phone:561-251-5190
Mailing Address - Street 1:6752 HERITAGE GRANDE
Mailing Address - Street 2:101
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-7926
Mailing Address - Country:US
Mailing Address - Phone:561-251-5190
Mailing Address - Fax:561-210-4304
Practice Address - Street 1:6752 HERITAGE GRANDE
Practice Address - Street 2:101
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-7926
Practice Address - Country:US
Practice Address - Phone:561-251-5190
Practice Address - Fax:561-210-4304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10006261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation