Provider Demographics
NPI:1376658450
Name:MANICANA HOME HEALTH AGENCY INC.
Entity Type:Organization
Organization Name:MANICANA HOME HEALTH AGENCY INC.
Other - Org Name:MANICANA HOME HEALTH AGENCY INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NICOLAS
Authorized Official - Middle Name:ANTOINE
Authorized Official - Last Name:FARANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-654-0043
Mailing Address - Street 1:633 NE 167TH ST
Mailing Address - Street 2:SUITE # 622
Mailing Address - City:N MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-2442
Mailing Address - Country:US
Mailing Address - Phone:305-654-0043
Mailing Address - Fax:305-654-0049
Practice Address - Street 1:633 NE 167TH ST
Practice Address - Street 2:SUITE # 622
Practice Address - City:N MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-2442
Practice Address - Country:US
Practice Address - Phone:305-654-0043
Practice Address - Fax:305-654-0049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108204Medicare ID - Type UnspecifiedMEDICARE ID NUMBER