MEDICARE: MALI HOME CARE AGENCY

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1528928264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MALI HOME CARE AGENCY

Provider Business Mailing Address
First Line	:	6525 MOORE ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-5944
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6525 MOORE ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-5944
Country	:	US
Telephone Number	:	954-394-2496
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MALIA BONHOMME GILLES
Credential	:	LPN
Telephone Number	:	954-394-2496

Provider Enumeration Date	:	11/14/2025
Last Update Date	:	11/14/2025

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