Provider Demographics
NPI:1790486603
Name:MARVELOUS ENTERPRISE LLC
Entity Type:Organization
Organization Name:MARVELOUS ENTERPRISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AMOS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARVEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-390-4686
Mailing Address - Street 1:18601 SHERMAN WAY # B156
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17965 ARCHWOOD ST
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-5627
Practice Address - Country:US
Practice Address - Phone:716-390-4686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARVELOUS ENTERPRISE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care