Healthcare Provider Details

I. General information

NPI: 1730607607
Provider Name (Legal Business Name): MBA IN-HOME SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 DAVIS BLVD
SIKESTON MO
63801-1958
US

IV. Provider business mailing address

PO BOX 1386
SIKESTON MO
63801-1386
US

V. Phone/Fax

Practice location:
  • Phone: 573-481-1088
  • Fax: 573-355-5925
Mailing address:
  • Phone: 573-481-1088
  • Fax: 573-355-5925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number6448
License Number StateMO

VIII. Authorized Official

Name: MISS RHONDA L WILLIAMS
Title or Position: OWNER/DIRECTOR
Credential: MASTER'S OF ARTS
Phone: 573-481-1088