{
"Npi": {
"NPI": "1750428371",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MISAGO HOME CARE, INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 2263",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DAYTONA BEACH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32115-2263",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "386-671-9571",
"MailingAddressFaxNumber": "386-671-9575",
"FirstLinePracticeLocationAddress": "801 W GRANADA BLVD",
"SecondLinePracticeLocationAddress": "SUITE 205",
"PracticeLocationAddressCityName": "ORMOND BEACH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32174-8114",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "386-671-9573",
"PracticeLocationAddressFaxNumber": "386-671-9575",
"EnumerationDate": "01/31/2007",
"LastUpdateDate": "09/11/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MISAGO",
"AuthorizedOfficialFirstName": "CLAVER",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "386-671-9571",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "229123",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "251J00000X",
"TaxonomyName": "Nursing Care Agency",
"LicenseNumber": "752",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}