Healthcare Provider Details

I. General information

NPI: 1245655836
Provider Name (Legal Business Name): MIZNER HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2014
Last Update Date: 04/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 SE MIZNER BLVD SUITE 213A
BOCA RATON FL
33432-5008
US

IV. Provider business mailing address

102 NE 2ND ST SUITE 409
BOCA RATON FL
33432-3908
US

V. Phone/Fax

Practice location:
  • Phone: 800-219-4304
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JOE NIETO
Title or Position: PRESIDENT
Credential:
Phone: 561-526-5516