Provider Demographics
NPI:1730235276
Name:MIHOM HEALTHCARE INC.
Entity type:Organization
Organization Name:MIHOM HEALTHCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:772-873-3838
Mailing Address - Street 1:2100 SE HILLMOOR DR
Mailing Address - Street 2:SUITE102
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-8057
Mailing Address - Country:US
Mailing Address - Phone:772-873-3838
Mailing Address - Fax:772-873-3839
Practice Address - Street 1:2100 SE HILLMOOR DR STE 102
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-8057
Practice Address - Country:US
Practice Address - Phone:772-873-3838
Practice Address - Fax:772-873-3839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299991919251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108106Medicare Oscar/Certification