Provider Demographics
NPI:1861434557
Name:MEDIASSIST HOME HEALTH CARE SERVICES AGENCY CORPORATION
Entity type:Organization
Organization Name:MEDIASSIST HOME HEALTH CARE SERVICES AGENCY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-971-7155
Mailing Address - Street 1:16235 SW 117TH AVE
Mailing Address - Street 2:UNIT 3
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-1644
Mailing Address - Country:US
Mailing Address - Phone:305-971-5155
Mailing Address - Fax:305-971-5156
Practice Address - Street 1:16235 SW 117TH AVE
Practice Address - Street 2:UNIT 3
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-1644
Practice Address - Country:US
Practice Address - Phone:305-971-5155
Practice Address - Fax:305-971-5156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299991776251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10D1101346OtherCLIA
FL299991776OtherAHCA
FL651004300Medicaid
FL299991776OtherAHCA