Provider Demographics
NPI:1851055925
Name:MICKEYCAREPLUS HEALTH CARE SERVICES LLC
Entity Type:Organization
Organization Name:MICKEYCAREPLUS HEALTH CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-822-1752
Mailing Address - Street 1:1717 E CAYUGA ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-6025
Mailing Address - Country:US
Mailing Address - Phone:813-822-1752
Mailing Address - Fax:
Practice Address - Street 1:1717 E CAYUGA ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-6025
Practice Address - Country:US
Practice Address - Phone:813-822-1752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-26
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health