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General NPI Number Information
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NPI Number | 1861222739
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Entity Type | Organization
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Legal Business Name | MABLE'S PLACE LLC
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Dates
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Enumeration Date | 08/06/2024
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Last Update Date | 08/06/2024
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Provider Practice Location Address
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Address Line | 3518 NORTHSIDE BLVD APT B7
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City | SOUTH BEND
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State | IN
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Zip | 46615-2041
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Country | US
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Telephone | 574-222-6080
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Fax |
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Provider Business Mailing Address
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Address Line | 3518 NORTHSIDE BLVD APT B7
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City | SOUTH BEND
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State | IN
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Zip | 46615-2041
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Country | US
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Telephone | 574-222-6080
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Fax |
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Authorized Official
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Title or Position | HOME HEALTH AGENCY
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Name | MS. TAKIYA MONIQUE LOVELADY
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Credential | LLC
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Telephone | 574-222-6080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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