Provider Demographics
NPI:1316316615
Name:MARIAN HOMECARE
Entity type:Organization
Organization Name:MARIAN HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:MORELAND
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA, CHCE, KMOB
Authorized Official - Phone:515-221-9155
Mailing Address - Street 1:12026 RIDGEMONT DR
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50323-2317
Mailing Address - Country:US
Mailing Address - Phone:515-221-9155
Mailing Address - Fax:515-221-9157
Practice Address - Street 1:12026 RIDGEMONT DR
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50323-2317
Practice Address - Country:US
Practice Address - Phone:515-221-9155
Practice Address - Fax:515-221-9157
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A GREAT LOVE COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care