1851717086 NPI number — MARANATHA CARE HOME HEALTH LLC

Table of content: (NPI 1851717086)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851717086 NPI number — MARANATHA CARE HOME HEALTH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARANATHA CARE HOME HEALTH LLC
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:
1851717086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12701 N I H 35
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JARRELL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76537-1114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-746-5147
Provider Business Mailing Address Fax Number:
512-746-2436

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 DOUBLE CREEK DR
Provider Second Line Business Practice Location Address:
12701 N I H 35
Provider Business Practice Location Address City Name:
JARRELL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76537-1114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-746-5147
Provider Business Practice Location Address Fax Number:
512-746-2436
Provider Enumeration Date:
03/12/2014

Additional Information

Authorized Official

Authorized Official Last Name:
RANSBURG RN
Authorized Official First Name:
GENNA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR/DON
Authorized Official Telephone Number:
512-746-5147

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  584121 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 747957 . This is a "MEDICARE PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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