1528384120 NPI number — MARY'S CARE HOME

Table of content: (NPI 1528384120)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528384120 NPI number — MARY'S CARE HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARY'S CARE HOME
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CALKINS TRANSPORT LLC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528384120
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9288 N LOST SAGE DR
Provider Second Line Business Mailing Address:
8746 STOCKTON HILL RD #17
Provider Business Mailing Address City Name:
KINGMAN
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86409-9359
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-692-6721
Provider Business Mailing Address Fax Number:
928-692-5408

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9288 N LOST SAGE DR
Provider Second Line Business Practice Location Address:
8746 STOCKON HILL RD #17
Provider Business Practice Location Address City Name:
KINGMAN
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86409-9359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-692-6721
Provider Business Practice Location Address Fax Number:
928-692-5408
Provider Enumeration Date:
04/08/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CALKIMS
Authorized Official First Name:
MARY
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
928-692-6721

Provider Taxonomy Codes

  • Taxonomy code: 311500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)