Provider Demographics
NPI:1043471857
Name:MARION PROVIDER CARE SERVICES, INC.
Entity Type:Organization
Organization Name:MARION PROVIDER CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BELLISSIA
Authorized Official - Middle Name:MARION
Authorized Official - Last Name:PANDY
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:904-537-5718
Mailing Address - Street 1:1010 E ADAMS ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-1902
Mailing Address - Country:US
Mailing Address - Phone:904-379-1528
Mailing Address - Fax:904-212-0615
Practice Address - Street 1:1010 E ADAMS ST
Practice Address - Street 2:SUITE 105
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-1902
Practice Address - Country:US
Practice Address - Phone:904-379-1528
Practice Address - Fax:904-212-0615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL687986198Medicaid
FL687986196Medicaid