Healthcare Provider Details

I. General information

NPI: 1639034077
Provider Name (Legal Business Name): YOHANAN CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 DIKEMAN ST # 211
HEMPSTEAD NY
11550-5143
US

IV. Provider business mailing address

137 DIKEMAN ST
HEMPSTEAD NY
11550-5143
US

V. Phone/Fax

Practice location:
  • Phone: 973-444-9191
  • Fax:
Mailing address:
  • Phone: 929-421-6511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MERCILLINA AWANYAI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 929-421-6511