Healthcare Provider Details

I. General information

NPI: 1225811938
Provider Name (Legal Business Name): NANA HOUSE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2053 N UNIVERSITY DR
SUNRISE FL
33322-3936
US

IV. Provider business mailing address

2053 N UNIVERSITY DR
SUNRISE FL
33322-3936
US

V. Phone/Fax

Practice location:
  • Phone: 305-975-4151
  • Fax:
Mailing address:
  • Phone: 305-975-4151
  • Fax: 954-302-2227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JASON JIMENO
Title or Position: CEO
Credential:
Phone: 305-975-4151