Provider Demographics
NPI:1124903729
Name:MEDURA HOME CARE LLC
Entity type:Organization
Organization Name:MEDURA HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MONIKA
Authorized Official - Middle Name:B
Authorized Official - Last Name:HANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-419-7122
Mailing Address - Street 1:40208 N LYTHAM WAY
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-2927
Mailing Address - Country:US
Mailing Address - Phone:586-419-7122
Mailing Address - Fax:
Practice Address - Street 1:8146 N 23RD AVE STE I
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-4907
Practice Address - Country:US
Practice Address - Phone:888-840-4030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care