Healthcare Provider Details

I. General information

NPI: 1891305892
Provider Name (Legal Business Name): NANA'S HOME CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 SE RAINIER RD
PORT SAINT LUCIE FL
34952-7612
US

IV. Provider business mailing address

2090 SE RAINIER RD
PORT SAINT LUCIE FL
34952-7612
US

V. Phone/Fax

Practice location:
  • Phone: 561-666-0049
  • Fax:
Mailing address:
  • Phone: 561-666-0049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MACDALIE AUMOITHE
Title or Position: ADMINISTRATOR
Credential: CNA
Phone: 561-666-0049