Provider Demographics
NPI:1255495842
Name:MAROLAND, LLC
Entity Type:Organization
Organization Name:MAROLAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:W
Authorized Official - Last Name:RICKETTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-796-3200
Mailing Address - Street 1:3721 RUTLEDGE ROAD. NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-5566
Mailing Address - Country:US
Mailing Address - Phone:505-796-3200
Mailing Address - Fax:505-796-3234
Practice Address - Street 1:3801 ATRISCO DR., NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-4903
Practice Address - Country:US
Practice Address - Phone:505-839-9888
Practice Address - Fax:505-839-7787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM000D4636251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000D4636Medicaid