Provider Demographics
NPI:1003159807
Name:MARY'S EXTREME CARE INC
Entity Type:Organization
Organization Name:MARY'S EXTREME CARE INC
Other - Org Name:GOOD MOVE ENTERPRICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:MELINDA
Authorized Official - Last Name:BARRY-AUSTIN
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:954-966-3530
Mailing Address - Street 1:6107 SW 26TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-3907
Mailing Address - Country:US
Mailing Address - Phone:954-966-3530
Mailing Address - Fax:954-963-0901
Practice Address - Street 1:6107 SW 26TH ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-3907
Practice Address - Country:US
Practice Address - Phone:954-966-3530
Practice Address - Fax:954-963-0901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11031310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility