Provider Demographics
NPI:1023733037
Name:IBSON HEALTH SERVICES LLC
Entity type:Organization
Organization Name:IBSON HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SOKARI
Authorized Official - Middle Name:OMUGBO
Authorized Official - Last Name:AFONYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-245-9436
Mailing Address - Street 1:4553 HAMPSHIRE AVE N
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55428-5147
Mailing Address - Country:US
Mailing Address - Phone:952-245-9436
Mailing Address - Fax:
Practice Address - Street 1:4553 HAMPSHIRE AVE N
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55428-5147
Practice Address - Country:US
Practice Address - Phone:218-280-7287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty