Provider Demographics
NPI:1598416166
Name:NIVLEM COMPANION & HOMEMAKER CARE LLC
Entity Type:Organization
Organization Name:NIVLEM COMPANION & HOMEMAKER CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MELLVVA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-770-3815
Mailing Address - Street 1:PO BOX 513
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33568-0513
Mailing Address - Country:US
Mailing Address - Phone:813-770-3815
Mailing Address - Fax:
Practice Address - Street 1:12948 TRADE PORT PL
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-4269
Practice Address - Country:US
Practice Address - Phone:813-770-3815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1821749706Medicaid