Healthcare Provider Details

I. General information

NPI: 1982509972
Provider Name (Legal Business Name): MOMO COMPANION CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11601 OTTAWA AVE
ORLANDO FL
32837-7713
US

IV. Provider business mailing address

11601 OTTAWA AVE
ORLANDO FL
32837-7713
US

V. Phone/Fax

Practice location:
  • Phone: 689-252-3502
  • Fax:
Mailing address:
  • Phone: 689-252-3502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL

VIII. Authorized Official

Name: MODELINE GUSTINVIL GUSTINVIL
Title or Position: ADMINISTRATOR
Credential:
Phone: 689-646-3470