Basic Information
| Provider Information | |||||||||
| NPI: | 1316316615 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MARIAN HOMECARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12026 RIDGEMONT DR | ||||||||
| Address2: | |||||||||
| City: | URBANDALE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503232317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152219155 | ||||||||
| FaxNumber: | 5152219157 | ||||||||
| Practice Location | |||||||||
| Address1: | 12026 RIDGEMONT DR | ||||||||
| Address2: | |||||||||
| City: | URBANDALE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503232317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152219155 | ||||||||
| FaxNumber: | 5152219157 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2015 | ||||||||
| LastUpdateDate: | 09/17/2015 | ||||||||
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| AuthorizedOfficialLastName: | MORELAND | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5152219155 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | A GREAT LOVE COMPANY | ||||||||
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| AuthorizedOfficialCredential: | MHSA, CHCE, KMOB | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 253Z00000X | Y | Agencies | In Home Supportive Care |
No ID Information.