Healthcare Provider Details

I. General information

NPI: 1972498590
Provider Name (Legal Business Name): MISSION HOME HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 POST RD STE 102
WARWICK RI
02888-1539
US

IV. Provider business mailing address

158 WARMAN AVE
CRANSTON RI
02920-3233
US

V. Phone/Fax

Practice location:
  • Phone: 401-440-5199
  • Fax:
Mailing address:
  • Phone: 401-440-5199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: BRYAN BORRAYO
Title or Position: PRESIDENT
Credential:
Phone: 401-440-5199