Provider Demographics
NPI:1164246393
Name:MAA SOULCARE DBA INTERIM HEALTH CARE
Entity type:Organization
Organization Name:MAA SOULCARE DBA INTERIM HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:RENU
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA VATS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-808-3585
Mailing Address - Street 1:185 N REDWOOD DR STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1965
Mailing Address - Country:US
Mailing Address - Phone:415-521-6847
Mailing Address - Fax:415-849-1237
Practice Address - Street 1:185 N REDWOOD DR STE 120
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-1965
Practice Address - Country:US
Practice Address - Phone:415-521-6847
Practice Address - Fax:415-849-1237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-13
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health