Provider Demographics
NPI:1477228542
Name:MG HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:MG HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YORDANKA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALONSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-908-2999
Mailing Address - Street 1:10200 NW 25TH ST STE 114
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-5919
Mailing Address - Country:US
Mailing Address - Phone:305-908-2999
Mailing Address - Fax:
Practice Address - Street 1:10200 NW 25TH ST STE 114
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-5919
Practice Address - Country:US
Practice Address - Phone:786-340-2687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MG HOME CARE SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-11
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017316400Medicaid