Provider Demographics
NPI:1265876239
Name:MARY CARE IN HOME CARE
Entity type:Organization
Organization Name:MARY CARE IN HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TISHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WRAGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-295-4656
Mailing Address - Street 1:811 MALLET HILL RD
Mailing Address - Street 2:211
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-4407
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:811 MALLET HILL RD
Practice Address - Street 2:211
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-4407
Practice Address - Country:US
Practice Address - Phone:513-295-4656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care