=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215889688
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MB PRIMARY HEALTH CAREGIVER SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2026
-----------------------------------------------------
Last Update Date | 02/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28149 HOT SPRINGS AVE
-----------------------------------------------------
City | CANYON COUNTRY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91351-1141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-213-7210
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28149 HOT SPRINGS AVE
-----------------------------------------------------
City | CANYON COUNTRY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91351-1141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-213-7210
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. MARILYN ALICIO BROENNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-213-7210
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------