Healthcare Provider Details

I. General information

NPI: 1508465725
Provider Name (Legal Business Name): MAHANAIM HOME CARE L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 N 29TH AVE STE 218B
HOLLYWOOD FL
33020-1521
US

IV. Provider business mailing address

2750 N 29 AVENUE SUITE 218B
HOLLYWOOD FL FL
33020-3982
US

V. Phone/Fax

Practice location:
  • Phone: 954-270-0563
  • Fax:
Mailing address:
  • Phone: 954-270-0563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MS. MYRIAM FRAZIL
Title or Position: PRESIDENT/CEO
Credential: R.N.
Phone: 954-270-0562