Provider Demographics
NPI:1467130633
Name:MARY NELL'S CLOSE TO HOME
Entity Type:Organization
Organization Name:MARY NELL'S CLOSE TO HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMINA
Authorized Official - Middle Name:REDIA
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-372-4043
Mailing Address - Street 1:12878 HWY 155 S
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-6539
Mailing Address - Country:US
Mailing Address - Phone:903-372-4043
Mailing Address - Fax:
Practice Address - Street 1:12878 HWY 155 S
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-6539
Practice Address - Country:US
Practice Address - Phone:903-372-4043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care