Healthcare Provider Details

I. General information

NPI: 1225746555
Provider Name (Legal Business Name): MOUNTAIN VIEW HOME HEALTHCARE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 05/06/2023
Certification Date: 05/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7971 RIVIERA BLVD STE 328
MIRAMAR FL
33023-6449
US

IV. Provider business mailing address

6953 SW 36TH DR
MIRAMAR FL
33023-6666
US

V. Phone/Fax

Practice location:
  • Phone: 786-541-3216
  • Fax:
Mailing address:
  • Phone: 754-223-0012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS KELISHA FERGUSON
Title or Position: CEO
Credential:
Phone: 754-223-0012