Healthcare Provider Details

I. General information

NPI: 1932003498
Provider Name (Legal Business Name): MUTIARA ELITE HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4233 DAISY HOLLOW LOOP
MESQUITE TX
75181-4395
US

IV. Provider business mailing address

4233 DAISY HOLLOW LOOP
MESQUITE TX
75181-4395
US

V. Phone/Fax

Practice location:
  • Phone: 678-654-1484
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MUTIAT AKOREDE
Title or Position: OWNER
Credential:
Phone: 678-654-1484