Provider Demographics
NPI:1588188817
Name:MRIENA HOME HEALTHCARE AGENCY LLC
Entity type:Organization
Organization Name:MRIENA HOME HEALTHCARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AWETASH
Authorized Official - Middle Name:TEDLA
Authorized Official - Last Name:AMARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-693-5155
Mailing Address - Street 1:3314 MORSE RD STE 204
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-6100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3314 MORSE RD STE 204
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-6100
Practice Address - Country:US
Practice Address - Phone:301-693-5155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-28
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0000000251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========Medicaid