Provider Demographics
NPI:1073994323
Name:OVWMARIEL LLC
Entity Type:Organization
Organization Name:OVWMARIEL LLC
Other - Org Name:INTERIM PERSONAL CARE AND SUPPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:V
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-393-9683
Mailing Address - Street 1:10954 GLAZER WAY
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-9394
Mailing Address - Country:US
Mailing Address - Phone:317-531-6992
Mailing Address - Fax:
Practice Address - Street 1:100 W 11TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-2069
Practice Address - Country:US
Practice Address - Phone:765-393-9683
Practice Address - Fax:765-393-9684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health