Provider Demographics
NPI:1356960231
Name:MIZASAY HOME CARE
Entity type:Organization
Organization Name:MIZASAY HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DWAYLON
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-412-2816
Mailing Address - Street 1:800 ELMIRA AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-4825
Mailing Address - Country:US
Mailing Address - Phone:252-226-2001
Mailing Address - Fax:
Practice Address - Street 1:800 ELMIRA AVE
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-4825
Practice Address - Country:US
Practice Address - Phone:252-226-2001
Practice Address - Fax:866-545-3560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-10
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care