Provider Demographics
NPI:1912760323
Name:MAB HOME HEALTH
Entity Type:Organization
Organization Name:MAB HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VARDANYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-979-1086
Mailing Address - Street 1:869 E FOOTHILL BLVD STE K
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4063
Mailing Address - Country:US
Mailing Address - Phone:909-979-1086
Mailing Address - Fax:818-698-6431
Practice Address - Street 1:869 E FOOTHILL BLVD STE K
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4063
Practice Address - Country:US
Practice Address - Phone:909-979-1086
Practice Address - Fax:818-698-6431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health