Provider Demographics
NPI:1629243050
Name:MISSION HOME CARE, INC.
Entity Type:Organization
Organization Name:MISSION HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:REYNALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:BASILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-355-4804
Mailing Address - Street 1:38332 DAUGHTERY ROAD
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33540
Mailing Address - Country:US
Mailing Address - Phone:813-355-4804
Mailing Address - Fax:813-355-4805
Practice Address - Street 1:38332 DAUGHTERY ROAD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33540
Practice Address - Country:US
Practice Address - Phone:813-355-4804
Practice Address - Fax:813-355-4805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-27
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLN/A251E00000X
FL299993638251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109614Medicare PIN