Provider Demographics
NPI:1881292084
Name:MARSICO ENTERPRISES, LLC
Entity type:Organization
Organization Name:MARSICO ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NABON
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MARSICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-277-8368
Mailing Address - Street 1:12924 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-1299
Mailing Address - Country:US
Mailing Address - Phone:815-922-5020
Mailing Address - Fax:
Practice Address - Street 1:400 W. LAKE STREET
Practice Address - Street 2:SUITE 112C
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172
Practice Address - Country:US
Practice Address - Phone:815-922-5020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care