=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861715047
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOBI ENTERPRISE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2010
-----------------------------------------------------
Last Update Date | 03/02/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 185 PARK HILL AVE APT 1Q
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10304-4766
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 862-755-3118
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 185 PARK HILL AVE APT 1Q
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10304-4766
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | INCORPORATOR
-----------------------------------------------------
Name | DR. PRUDENCE NWOBI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 862-755-3118
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 283842-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------