Provider Demographics
NPI:1730923491
Name:MAFASHOMECARE
Entity type:Organization
Organization Name:MAFASHOMECARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOSS
Authorized Official - Prefix:
Authorized Official - First Name:LAVERNA
Authorized Official - Middle Name:F
Authorized Official - Last Name:LESA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-404-0937
Mailing Address - Street 1:3004 W 1350 N
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-5793
Mailing Address - Country:US
Mailing Address - Phone:801-404-0937
Mailing Address - Fax:
Practice Address - Street 1:3004 W 1350 N
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-5793
Practice Address - Country:US
Practice Address - Phone:801-404-0937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-19
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care