Provider Demographics
NPI:1215570338
Name:MOXMAN HOME CARE LLC
Entity Type:Organization
Organization Name:MOXMAN HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:MOXAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-289-0117
Mailing Address - Street 1:115 COVINGTON CV SE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-4555
Mailing Address - Country:US
Mailing Address - Phone:863-875-4376
Mailing Address - Fax:
Practice Address - Street 1:44 4TH ST SW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-2910
Practice Address - Country:US
Practice Address - Phone:863-877-3992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL299994949OtherHOME HEALTH AGENCY (ISSUED BY AHCA)