Provider Demographics
NPI:1306019740
Name:MAKAVIC HOME HEALTH LLC
Entity Type:Organization
Organization Name:MAKAVIC HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OLUWATOYIN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLUWASOLA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:817-455-7005
Mailing Address - Street 1:2307 OAK LN STE 213
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-8285
Mailing Address - Country:US
Mailing Address - Phone:972-639-3220
Mailing Address - Fax:972-639-3313
Practice Address - Street 1:2307 OAK LN STE 213
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-8285
Practice Address - Country:US
Practice Address - Phone:972-639-3220
Practice Address - Fax:972-639-3313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010270251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679723Medicare Oscar/Certification