MEDICARE: NANA HOUSE INC

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	324500000X	Substance Abuse Rehabilitation Facility
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225811938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NANA HOUSE INC

Provider Business Mailing Address
First Line	:	2053 N UNIVERSITY DR
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33322-3936
Country	:	US
Telephone Number	:	305-975-4151
Fax Number	:	954-302-2227

Provider Business Practice Location Address
First Line	:	2053 N UNIVERSITY DR
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33322-3936
Country	:	US
Telephone Number	:	305-975-4151
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. JASON JIMENO
Credential	:
Telephone Number	:	305-975-4151

Provider Enumeration Date	:	08/16/2023
Last Update Date	:	04/08/2026

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Directions to “NANA HOUSE INC ” Practice Location

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