MEDICARE: MANDISA HALL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	666542	NY

General Provider Information

NPI Number	:	1144563289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANDISA HALL

Provider Business Mailing Address
First Line	:	511 CLEVELAND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-2119
Country	:	US
Telephone Number	:	718-235-1340
Fax Number	:

Provider Business Practice Location Address
First Line	:	511 CLEVELAND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-2119
Country	:	US
Telephone Number	:	718-235-1340
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED NURSE
Name	:	MANDISA JANET HALL
Credential	:	REGISTERED NURSE
Telephone Number	:	718-235-1340

Provider Enumeration Date	:	03/27/2013
Last Update Date	:	03/27/2013

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