Makavic Home Health LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

010270 Issued in TX

Legal business name

MAKAVIC HOME HEALTH LLC

Practice address

2307 Oak LN Ste 213
Grand Prairie, TX 75051-8285

Phone

(972) 639-3220

Fax

(972) 639-3313

NPI assigned

Apr 7, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Oluwatoyin Oluwasola, RN

Title

Owner/Administrator

Phone

(817) 455-7005

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Home health agency certification: CCN 679723

Legal name

MAKAVIC HOME HEALTH, LLC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Oct 9, 2007

Last certification

Mar 23, 2021

Ownership / control type

Proprietary

Organization structure

LLCProprietary

Incorporated

Oct 31, 2005 in TX

Enrollment address

2307 Oak Lane
Suite 213
Grand Prairie, TX 75051-8285

Listed as

Makavic Home Health LLCCCN 679723

Overall star rating

1.5 of 5

Ownership

Proprietary

Certified

Oct 9, 2007

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Kimberli Nekishia Johnson, M.D.

  • Internal Medicine Physician
  • Plano, TX
  • NPI 1992996680

  Home health agency

  Care Compare affiliation
• Bhaviniben S Patel, M.D.

  • Family Medicine Physician
  • Mount Pleasant, TX
  • NPI 1437491727

  Home health agency

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1207526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467158400000",
    "number": "1306019740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2307 OAK LN STE 213",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750518285",
            "telephone_number": "972-639-3220",
            "fax_number": "972-639-3313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2307 OAK LN STE 213",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750518285",
            "telephone_number": "972-639-3220",
            "fax_number": "972-639-3313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAKAVIC HOME HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-07",
        "last_updated": "2016-06-29",
        "status": "A",
        "authorized_official_last_name": "OLUWASOLA",
        "authorized_official_first_name": "OLUWATOYIN",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "817-455-7005",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "TX",
            "license": "010270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Home Health Agency in Grand Prairie, TX
• Providers in Grand Prairie, TX by specialty
• Home Health Agency in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.