Provider Demographics
NPI:1750428371
Name:MISAGO HOME CARE, INC
Entity type:Organization
Organization Name:MISAGO HOME CARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAVER
Authorized Official - Middle Name:
Authorized Official - Last Name:MISAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-671-9571
Mailing Address - Street 1:PO BOX 2263
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32115-2263
Mailing Address - Country:US
Mailing Address - Phone:386-671-9571
Mailing Address - Fax:386-671-9575
Practice Address - Street 1:801 W GRANADA BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8114
Practice Address - Country:US
Practice Address - Phone:386-671-9573
Practice Address - Fax:386-671-9575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL229123251E00000X
FL752251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251E00000XAgenciesHome Health
Not Answered251J00000XAgenciesNursing Care