Healthcare Provider Details

I. General information

NPI: 1700330255
Provider Name (Legal Business Name): MOLINA HOME CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2016
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5918 BENT PINE DR 213
ORLANDO FL
32822-3338
US

IV. Provider business mailing address

5918 BENT PINE DR 213
ORLANDO FL
32822-3338
US

V. Phone/Fax

Practice location:
  • Phone: 407-906-0560
  • Fax: 407-209-0049
Mailing address:
  • Phone: 407-906-0560
  • 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 Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELISSA MOLINA
Title or Position: PRESIDENT/CEO
Credential:
Phone: 407-906-0560