Provider Demographics
NPI:1417696063
Name:MARIE'S PERSONAL HOME CARE
Entity Type:Organization
Organization Name:MARIE'S PERSONAL HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUDENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-615-1037
Mailing Address - Street 1:204 DUPONT CT
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-5844
Mailing Address - Country:US
Mailing Address - Phone:478-918-4040
Mailing Address - Fax:
Practice Address - Street 1:5205 BUENA VISTA RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-5164
Practice Address - Country:US
Practice Address - Phone:706-615-1037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care