Provider Demographics
NPI:1497527279
Name:MARYS HOMECARE LLC
Entity Type:Organization
Organization Name:MARYS HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAUNDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-668-4269
Mailing Address - Street 1:5201 BOGDONOFF DR APT A
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-6447
Mailing Address - Country:US
Mailing Address - Phone:813-668-4269
Mailing Address - Fax:
Practice Address - Street 1:5201 BOGDONOFF DR APT A
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-6447
Practice Address - Country:US
Practice Address - Phone:813-668-4269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health