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General NPI Number Information
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NPI Number | 1306019740
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Entity Type | Organization
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Legal Business Name | MAKAVIC HOME HEALTH LLC
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Dates
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Enumeration Date | 04/07/2008
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Last Update Date | 06/29/2016
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Provider Practice Location Address
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Address Line | 2307 OAK LN STE 213
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City | GRAND PRAIRIE
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State | TX
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Zip | 75051-8285
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Country | US
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Telephone | 972-639-3220
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Fax | 972-639-3313
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Provider Business Mailing Address
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Address Line | 2307 OAK LN STE 213
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City | GRAND PRAIRIE
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State | TX
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Zip | 75051-8285
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Country | US
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Telephone | 972-639-3220
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Fax | 972-639-3313
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MR. OLUWATOYIN OLUWASOLA
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Credential | RN
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Telephone | 817-455-7005
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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 | 010270
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License Number State | TX
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