Provider Demographics
NPI:1215715263
Name:MY NANA'S HOUSE, LLC
Entity type:Organization
Organization Name:MY NANA'S HOUSE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH CARE PROFESSIONAL
Authorized Official - Prefix:
Authorized Official - First Name:ZELMA
Authorized Official - Middle Name:
Authorized Official - Last Name:IZLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:868-642-0709
Mailing Address - Street 1:201 WEST LN APT 606
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631-1298
Mailing Address - Country:US
Mailing Address - Phone:864-207-0952
Mailing Address - Fax:
Practice Address - Street 1:201 WEST LN APT 606
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-1298
Practice Address - Country:US
Practice Address - Phone:864-207-0952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health