Provider Demographics
NPI:1780248716
Name:CARGILL, MARRISHA
Entity type:Individual
Prefix:
First Name:MARRISHA
Middle Name:
Last Name:CARGILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19960 CONCORD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-2915
Mailing Address - Country:US
Mailing Address - Phone:313-455-0112
Mailing Address - Fax:
Practice Address - Street 1:4319 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-3622
Practice Address - Country:US
Practice Address - Phone:313-346-3387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide