Provider Demographics
NPI:1346670825
Name:MAREAS VILLIAGE CARE & SERVICES INC.
Entity Type:Organization
Organization Name:MAREAS VILLIAGE CARE & SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:RICOT
Authorized Official - Last Name:MAREUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-305-8248
Mailing Address - Street 1:2420 NW 104TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-1235
Mailing Address - Country:US
Mailing Address - Phone:305-305-8248
Mailing Address - Fax:
Practice Address - Street 1:2420 NW 104TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-1235
Practice Address - Country:US
Practice Address - Phone:305-305-8248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL233340320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities