Provider Demographics
NPI:1255762282
Name:MARANVILLE ENTERPRISES, INC
Entity type:Organization
Organization Name:MARANVILLE ENTERPRISES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MARANVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:928-237-4116
Mailing Address - Street 1:119 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-2913
Mailing Address - Country:US
Mailing Address - Phone:928-237-4116
Mailing Address - Fax:928-759-2612
Practice Address - Street 1:119 GARDEN ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-2913
Practice Address - Country:US
Practice Address - Phone:928-237-4116
Practice Address - Fax:928-759-2612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No173C00000XOther Service ProvidersReflexologistGroup - Single Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty