Provider Demographics
NPI:1528165305
Name:MIRAMAR HOME HEALTH, INC
Entity type:Organization
Organization Name:MIRAMAR HOME HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:985-651-9445
Mailing Address - Street 1:2913 WILLIAMSBURG DR
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-2115
Mailing Address - Country:US
Mailing Address - Phone:985-651-1102
Mailing Address - Fax:985-651-1120
Practice Address - Street 1:2913 WILLIAMSBURG DR
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-2115
Practice Address - Country:US
Practice Address - Phone:985-651-1102
Practice Address - Fax:985-651-1120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA423251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1400343Medicaid
LA197435Medicare ID - Type UnspecifiedPROVIDER NUMBER