1285840934 NPI number — MARC COMMUNITY RESOURCES, INC.

Table of content: (NPI 1285840934)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285840934 NPI number — MARC COMMUNITY RESOURCES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARC COMMUNITY RESOURCES, INC.
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:
Provider Other Organization Name Type Code:
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:
1285840934
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
924 N COUNTRY CLUB DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85201-4108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-969-3700
Provider Business Mailing Address Fax Number:
480-644-1557

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
737 W GUADALUPE RD
Provider Second Line Business Practice Location Address:
SUITE NUMBERS 101-112 123-124
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-969-3800
Provider Business Practice Location Address Fax Number:
480-644-1557
Provider Enumeration Date:
05/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BROOKS
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
Authorized Official Title or Position:
SR DIRECTOR OF CONTRACTOR OPERATION
Authorized Official Telephone Number:
480-969-3800

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 215312 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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