Provider Demographics
NPI:1235796681
Name:MARVERLY ENTERPRISES, LLC
Entity Type:Organization
Organization Name:MARVERLY ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-382-5876
Mailing Address - Street 1:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:CUBERO
Mailing Address - State:NM
Mailing Address - Zip Code:87014-0176
Mailing Address - Country:US
Mailing Address - Phone:505-382-5876
Mailing Address - Fax:
Practice Address - Street 1:1405 NM HWY 124
Practice Address - Street 2:
Practice Address - City:CUBERO
Practice Address - State:NM
Practice Address - Zip Code:87014
Practice Address - Country:US
Practice Address - Phone:505-382-5876
Practice Address - Fax:505-933-3458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM3627OtherHOME HEALTH CARE AGENCY