Provider Demographics
NPI:1215636154
Name:MINA HOME CARE AGENCY, INC
Entity type:Organization
Organization Name:MINA HOME CARE AGENCY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NA
Authorized Official - Middle Name:
Authorized Official - Last Name:HU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-443-9698
Mailing Address - Street 1:2523 SHERBORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-3054
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3243 RICE CT
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-1544
Practice Address - Country:US
Practice Address - Phone:260-443-9698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care