Provider Demographics
NPI:1730607607
Name:MBA IN-HOME SERVICES LLC
Entity type:Organization
Organization Name:MBA IN-HOME SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MASTER'S OF ARTS
Authorized Official - Phone:573-481-1088
Mailing Address - Street 1:PO BOX 1386
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-1386
Mailing Address - Country:US
Mailing Address - Phone:573-481-1088
Mailing Address - Fax:573-355-5925
Practice Address - Street 1:613 DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-1958
Practice Address - Country:US
Practice Address - Phone:573-481-1088
Practice Address - Fax:573-355-5925
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MBA IN-HOME SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-31
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO6448302F00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO23454555OtherMISSOURI