Provider Demographics
NPI:1821639873
Name:MARSHANNIE'S HOME CARE, LLC
Entity Type:Organization
Organization Name:MARSHANNIE'S HOME CARE, LLC
Other - Org Name:MARSHANNIE'S HOME CARE, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GRISHANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-603-7888
Mailing Address - Street 1:2143 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19122-1749
Mailing Address - Country:US
Mailing Address - Phone:267-603-7888
Mailing Address - Fax:
Practice Address - Street 1:2143 N FRONT STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19122
Practice Address - Country:US
Practice Address - Phone:267-603-7888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-01
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103622858-0001Medicaid