Provider Demographics
NPI:1700502275
Name:MAYFAIR HOME HEALTH LLC
Entity Type:Organization
Organization Name:MAYFAIR HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUTINTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MULEYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-447-7411
Mailing Address - Street 1:11872 EMERY VILLAGE DR N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-2490
Mailing Address - Country:US
Mailing Address - Phone:763-447-7411
Mailing Address - Fax:
Practice Address - Street 1:11872 EMERY VILLAGE DR N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-2490
Practice Address - Country:US
Practice Address - Phone:763-447-7411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center