Provider Demographics
NPI:1790700409
Name:MAM HEALTH ENTERPRISES INC.
Entity Type:Organization
Organization Name:MAM HEALTH ENTERPRISES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DON
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ANTONIA
Authorized Official - Last Name:MONZON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-267-7895
Mailing Address - Street 1:1350 SW 57TH AVE
Mailing Address - Street 2:315
Mailing Address - City:WEST MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-5775
Mailing Address - Country:US
Mailing Address - Phone:305-267-7895
Mailing Address - Fax:305-267-7896
Practice Address - Street 1:1350 SW 57TH AVE
Practice Address - Street 2:315
Practice Address - City:WEST MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-5775
Practice Address - Country:US
Practice Address - Phone:305-267-7895
Practice Address - Fax:305-267-7896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2999942436251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL651392100Medicaid
FL651392100Medicaid