Provider Demographics
NPI:1336408863
Name:MARYWAY HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:MARYWAY HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FASORO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-896-6039
Mailing Address - Street 1:3329 HARBOURTOWN DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-7796
Mailing Address - Country:US
Mailing Address - Phone:817-896-6039
Mailing Address - Fax:972-606-1860
Practice Address - Street 1:3329 HARBOURTOWN DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-7796
Practice Address - Country:US
Practice Address - Phone:817-896-6039
Practice Address - Fax:972-606-1860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health