MEDICARE: MBC HOME HEALTH SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	550000091	CA

General Provider Information

NPI Number	:	1629124557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MBC HOME HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	2777 WEST BROADWAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-1038
Country	:	US
Telephone Number	:	323-254-5399
Fax Number	:	323-254-5624

Provider Business Practice Location Address
First Line	:	2777 WEST BROADWAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-1038
Country	:	US
Telephone Number	:	323-254-5399
Fax Number	:	323-254-5624

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. REYNALDO C DIZON
Credential	:
Telephone Number	:	323-254-5399

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	09/11/2009

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