Provider Demographics
NPI:1144948407
Name:MY VILLAGE HOMECARE LLC
Entity type:Organization
Organization Name:MY VILLAGE HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AWONIYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-617-9406
Mailing Address - Street 1:513 ROLIN HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:TN
Mailing Address - Zip Code:38449-3106
Mailing Address - Country:US
Mailing Address - Phone:256-617-9406
Mailing Address - Fax:
Practice Address - Street 1:4613 CALVERT RD NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35816-1403
Practice Address - Country:US
Practice Address - Phone:256-475-0533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care