MEDICARE: MR. SAMUEL MUTIZWA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1437820289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SAMUEL MUTIZWA

Provider Business Mailing Address
First Line	:	1936 CLIFFROSE DR
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-5790
Country	:	US
Telephone Number	:	940-279-5085
Fax Number	:	469-777-3995

Provider Business Practice Location Address
First Line	:	1936 CLIFFROSE DR
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-5790
Country	:	US
Telephone Number	:	940-279-5085
Fax Number	:	469-777-3995

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2021
Last Update Date	:	09/22/2021

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