Healthcare Provider Details

I. General information

NPI: 1215570338
Provider Name (Legal Business Name): MOXMAN HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 4TH ST SW
WINTER HAVEN FL
33880-2910
US

IV. Provider business mailing address

115 COVINGTON CV SE
WINTER HAVEN FL
33880-4555
US

V. Phone/Fax

Practice location:
  • Phone: 863-877-3992
  • Fax:
Mailing address:
  • Phone: 863-875-4376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: BRANDON MOXAM
Title or Position: MEMBER
Credential:
Phone: 863-289-0117