Provider Demographics
NPI:1861469066
Name:MARIAN HOME HEALTHCARE
Entity Type:Organization
Organization Name:MARIAN HOME HEALTHCARE
Other - Org Name:MERCY HOME CARE-SIOUX CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-279-5850
Mailing Address - Street 1:711 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1302
Mailing Address - Country:US
Mailing Address - Phone:712-233-5151
Mailing Address - Fax:712-233-5156
Practice Address - Street 1:711 5TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1302
Practice Address - Country:US
Practice Address - Phone:712-233-5151
Practice Address - Fax:712-233-5156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0148684Medicaid
SD9165160Medicaid
NE=========62Medicaid
NE=========62Medicaid