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General NPI Number Information
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NPI Number | 1174965990
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Entity Type | Organization
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Legal Business Name | MISSIONARY HOME HEALTH CARE CORPORATION
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Dates
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Enumeration Date | 07/22/2013
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Last Update Date | 07/22/2013
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Provider Practice Location Address
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Address Line | 950 NW 180TH TER
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City | MIAMI GARDENS
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State | FL
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Zip | 33169-4223
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Country | US
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Telephone | 786-263-8004
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Fax |
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Provider Business Mailing Address
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Address Line | 950 NW 180TH TER
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City | MIAMI GARDENS
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State | FL
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Zip | 33169-4223
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Country | US
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Telephone | 786-263-8004
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. IKESHA RENEE WHITE
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Credential |
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Telephone | 786-263-8004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | N04000011057
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License Number State | FL
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