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General NPI Number Information
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NPI Number | 1528412061
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Entity Type | Organization
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Legal Business Name | KABAMEDICALCORPORATION
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Dates
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Enumeration Date | 04/21/2016
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Last Update Date | 04/21/2016
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Provider Practice Location Address
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Address Line | 484LOWELL STREET
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City | PEABODY
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State | MA
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Zip | 01960
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Country | US
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Telephone | 978-278-5472
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Fax | 978-817-2991
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Provider Business Mailing Address
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Address Line | 484 LOWELL ST STE 1B-1
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City | PEABODY
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State | MA
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Zip | 01960-7928
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Country | US
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Telephone | 978-278-5472
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Fax | 978-817-2991
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. LASANA B KABA SR.
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Credential |
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Telephone | 978-278-5472
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BN1400X
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Taxonomy Name | Nursing Facility Supplies (DME)
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License Number | 00121624
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License Number State | MA
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