Provider Demographics
NPI:1144563289
Name:MANDISA HALL
Entity Type:Organization
Organization Name:MANDISA HALL
Other - Org Name:PIONEER HOMECARE
Other - Org Type:Other Name
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:
Authorized Official - First Name:MANDISA
Authorized Official - Middle Name:JANET
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:718-235-1340
Mailing Address - Street 1:511 CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-2119
Mailing Address - Country:US
Mailing Address - Phone:718-235-1340
Mailing Address - Fax:
Practice Address - Street 1:511 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-2119
Practice Address - Country:US
Practice Address - Phone:718-235-1340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY666542251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health