Provider Demographics
NPI:1902183528
Name:MENOMARK LLC
Entity Type:Organization
Organization Name:MENOMARK LLC
Other - Org Name:AT HOME NEIGHBORLY NURSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MENO
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:440-476-7754
Mailing Address - Street 1:26777 LORAIN RD
Mailing Address - Street 2:SUITE 711
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-3200
Mailing Address - Country:US
Mailing Address - Phone:440-476-7754
Mailing Address - Fax:440-508-2373
Practice Address - Street 1:26777 LORAIN RD
Practice Address - Street 2:SUITE 711
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3200
Practice Address - Country:US
Practice Address - Phone:440-476-7754
Practice Address - Fax:440-508-2373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health