Provider Demographics
NPI:1982358511
Name:MBG HOME CARE
Entity Type:Organization
Organization Name:MBG HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:B
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:956-357-7802
Mailing Address - Street 1:2017 E TYLER AVE
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-7388
Mailing Address - Country:US
Mailing Address - Phone:956-300-2000
Mailing Address - Fax:
Practice Address - Street 1:2017 E TYLER AVE
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7388
Practice Address - Country:US
Practice Address - Phone:956-300-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory