Provider Demographics
NPI:1245403732
Name:M D M HOME HEALTH CORPORATION
Entity Type:Organization
Organization Name:M D M HOME HEALTH CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MESA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-253-2763
Mailing Address - Street 1:17358 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:PERRINE
Mailing Address - State:FL
Mailing Address - Zip Code:33157-4319
Mailing Address - Country:US
Mailing Address - Phone:305-253-2763
Mailing Address - Fax:305-253-2767
Practice Address - Street 1:17358 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:PERRINE
Practice Address - State:FL
Practice Address - Zip Code:33157-4319
Practice Address - Country:US
Practice Address - Phone:305-253-2763
Practice Address - Fax:305-253-2767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health