Provider Demographics
NPI:1538915632
Name:MIRDOH HEALTH LLC
Entity type:Organization
Organization Name:MIRDOH HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EDMUND
Authorized Official - Middle Name:
Authorized Official - Last Name:GYANDOH
Authorized Official - Suffix:
Authorized Official - Credentials:DBA, PMP
Authorized Official - Phone:505-930-1000
Mailing Address - Street 1:3900 PASEO DEL SOL
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-4072
Mailing Address - Country:US
Mailing Address - Phone:505-930-1000
Mailing Address - Fax:
Practice Address - Street 1:3900 PASEO DEL SOL
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4072
Practice Address - Country:US
Practice Address - Phone:505-930-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-29
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care