Provider Demographics
NPI:1205088598
Name:MA HOME HEALTH LLC
Entity type:Organization
Organization Name:MA HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:FUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-551-6531
Mailing Address - Street 1:2500 SW 107TH AVE
Mailing Address - Street 2:SUITE 29
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2470
Mailing Address - Country:US
Mailing Address - Phone:305-551-6531
Mailing Address - Fax:305-551-6532
Practice Address - Street 1:2500 SW 107TH AVE
Practice Address - Street 2:SUITE 29
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2470
Practice Address - Country:US
Practice Address - Phone:305-551-6531
Practice Address - Fax:305-551-6532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-17
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
FL299993054251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies