Provider Demographics
NPI:1275854515
Name:MARABLE'S HEART-TO-HEART PCH INC
Entity Type:Organization
Organization Name:MARABLE'S HEART-TO-HEART PCH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ULYSSES
Authorized Official - Middle Name:
Authorized Official - Last Name:MARABLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:229-263-6553
Mailing Address - Street 1:83 CHURCH LANE
Mailing Address - Street 2:MARABLE'S HEART-TO-HEART PERSONAL CARE HOME INC.
Mailing Address - City:QUITMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31643
Mailing Address - Country:US
Mailing Address - Phone:229-263-6553
Mailing Address - Fax:229-263-6553
Practice Address - Street 1:83 CHURCH LANE
Practice Address - Street 2:MARABLE'S HEART-TO-HEART PERSONAL CARE HOME INC.
Practice Address - City:QUITMAN
Practice Address - State:GA
Practice Address - Zip Code:31643
Practice Address - Country:US
Practice Address - Phone:229-263-6553
Practice Address - Fax:229-263-6553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-22
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014-01-011-1251E00000X, 320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA532599858AMedicaid