Healthcare Provider Details

I. General information

NPI: 1225910615
Provider Name (Legal Business Name): MNTBLO HOME HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W BEVERLY BLVD STE A-1
MONTEBELLO CA
90640-4305
US

IV. Provider business mailing address

104 W BEVERLY BLVD STE A-1
MONTEBELLO CA
90640-4305
US

V. Phone/Fax

Practice location:
  • Phone: 419-777-1777
  • Fax:
Mailing address:
  • Phone: 419-777-1777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANNA BONDARENKO
Title or Position: CEO
Credential:
Phone: 419-777-1777