Provider Demographics
NPI:1649546086
Name:JABA LLC
Entity type:Organization
Organization Name:JABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANGELO
Authorized Official - Last Name:BADIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-839-8783
Mailing Address - Street 1:6292 DOWNPOUR CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-5037
Mailing Address - Country:US
Mailing Address - Phone:702-839-8775
Mailing Address - Fax:
Practice Address - Street 1:6292 DOWNPOUR CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-5037
Practice Address - Country:US
Practice Address - Phone:702-839-8775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty