Provider Demographics
NPI:1164419446
Name:MARSHALL MANOR HOMECARE, LLC
Entity Type:Organization
Organization Name:MARSHALL MANOR HOMECARE, LLC
Other - Org Name:MANOR HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GOVERNING BODY MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:903-923-8154
Mailing Address - Street 1:1108 ELSIE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-6278
Mailing Address - Country:US
Mailing Address - Phone:903-923-8154
Mailing Address - Fax:903-923-8624
Practice Address - Street 1:1108 ELSIE ST
Practice Address - Street 2:SUITE A
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-6278
Practice Address - Country:US
Practice Address - Phone:903-923-8154
Practice Address - Fax:903-923-8624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009761251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45-7878Medicare ID - Type Unspecified