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General NPI Number Information
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NPI Number | 1164246393
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Entity Type | Organization
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Legal Business Name | MAA SOULCARE DBA INTERIM HEALTH CARE
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 185 N REDWOOD DR STE 120
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City | SAN RAFAEL
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State | CA
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Zip | 94903-1965
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Country | US
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Telephone | 415-521-6847
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Fax | 415-849-1237
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Provider Business Mailing Address
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Address Line | 185 N REDWOOD DR STE 120
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City | SAN RAFAEL
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State | CA
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Zip | 94903-1965
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Country | US
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Telephone | 415-521-6847
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Fax | 415-849-1237
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Authorized Official
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Title or Position | VP
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Name | RENU SHARMA VATS
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Credential |
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Telephone | 909-808-3585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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