Healthcare Provider Details

I. General information

NPI: 1477228542
Provider Name (Legal Business Name): MG HOME CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 NW 25TH ST STE 114
DORAL FL
33172-5919
US

IV. Provider business mailing address

10200 NW 25TH ST STE 114
DORAL FL
33172-5919
US

V. Phone/Fax

Practice location:
  • Phone: 786-340-2687
  • Fax:
Mailing address:
  • Phone: 305-908-2999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: YORDANKA ALONSO
Title or Position: ADMINISTRATOR
Credential:
Phone: 305-908-2999