Provider Demographics
NPI:1588297006
Name:MARLEY ADULT HEALTHCARE LLC
Entity type:Organization
Organization Name:MARLEY ADULT HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COSTEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TIRDEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-228-7320
Mailing Address - Street 1:14798 W GEORGIA DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-4243
Mailing Address - Country:US
Mailing Address - Phone:602-228-7320
Mailing Address - Fax:623-251-4758
Practice Address - Street 1:14798 W GEORGIA DR
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-4243
Practice Address - Country:US
Practice Address - Phone:602-228-7320
Practice Address - Fax:623-251-4758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home