MEDICARE: MICKEYCAREPLUS HEALTH CARE SERVICES LLC

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

General Provider Information

NPI Number	:	1851055925
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICKEYCAREPLUS HEALTH CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	1717 E CAYUGA ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-6025
Country	:	US
Telephone Number	:	813-822-1752
Fax Number	:

Provider Business Practice Location Address
First Line	:	1717 E CAYUGA ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-6025
Country	:	US
Telephone Number	:	813-822-1752
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MANETTE GRAHAM
Credential	:
Telephone Number	:	813-822-1752

Provider Enumeration Date	:	10/26/2021
Last Update Date	:	12/28/2021

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