Provider Demographics
NPI:1316701253
Name:MARIAM HOME CARE AGENCY LLC
Entity type:Organization
Organization Name:MARIAM HOME CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WINNIE
Authorized Official - Middle Name:ANNIE
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:516-424-9571
Mailing Address - Street 1:2 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16125-2318
Mailing Address - Country:US
Mailing Address - Phone:516-424-9571
Mailing Address - Fax:
Practice Address - Street 1:2 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-2318
Practice Address - Country:US
Practice Address - Phone:516-424-9571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health