Provider Demographics
NPI:1851736219
Name:MARY AND MARY CAREGIVERS
Entity Type:Organization
Organization Name:MARY AND MARY CAREGIVERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NHAJIYAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:803-394-0279
Mailing Address - Street 1:529 HUMBLE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-5435
Mailing Address - Country:US
Mailing Address - Phone:803-394-0279
Mailing Address - Fax:
Practice Address - Street 1:529 HUMBLE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-5435
Practice Address - Country:US
Practice Address - Phone:803-394-0279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-29
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2013-34640-33770251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health