Provider Demographics
NPI:1255125662
Name:MARYLOUS HOMECARE
Entity type:Organization
Organization Name:MARYLOUS HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LOGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPPARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-290-3667
Mailing Address - Street 1:6130 ALBERT LN
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MN
Mailing Address - Zip Code:55056-3303
Mailing Address - Country:US
Mailing Address - Phone:952-290-3667
Mailing Address - Fax:952-290-3667
Practice Address - Street 1:6130 ALBERT LN
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056-3303
Practice Address - Country:US
Practice Address - Phone:952-290-3667
Practice Address - Fax:952-290-3667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care