Provider Demographics
NPI:1578573952
Name:MARIAN HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:MARIAN HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SALVADOR
Authorized Official - Middle Name:CAOILI
Authorized Official - Last Name:SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-290-1740
Mailing Address - Street 1:500 E HIGGINS RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-1438
Mailing Address - Country:US
Mailing Address - Phone:847-290-1740
Mailing Address - Fax:847-290-1760
Practice Address - Street 1:500 E HIGGINS RD
Practice Address - Street 2:SUITE 210
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-1438
Practice Address - Country:US
Practice Address - Phone:847-290-1740
Practice Address - Fax:847-290-1760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1747748251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1747748OtherLICENSE NUMBER
IL1010394OtherSTATE ID
IL1747748OtherLICENSE NUMBER