Provider Demographics
NPI:1356936652
Name:MARY LOUISE HOMECARE LLC
Entity type:Organization
Organization Name:MARY LOUISE HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:FREDERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-264-7520
Mailing Address - Street 1:4768 WOODVILLE HWY APT 411
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32305-0955
Mailing Address - Country:US
Mailing Address - Phone:850-264-7520
Mailing Address - Fax:
Practice Address - Street 1:4768 WOODVILLE HWY APT 411
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32305-0955
Practice Address - Country:US
Practice Address - Phone:850-264-7520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty