Provider Demographics
NPI:1851717086
Name:MARANATHA CARE HOME HEALTH LLC
Entity type:Organization
Organization Name:MARANATHA CARE HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DON
Authorized Official - Prefix:MS
Authorized Official - First Name:GENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:RANSBURG RN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:512-746-5147
Mailing Address - Street 1:12701 N I H 35
Mailing Address - Street 2:
Mailing Address - City:JARRELL
Mailing Address - State:TX
Mailing Address - Zip Code:76537-1114
Mailing Address - Country:US
Mailing Address - Phone:512-746-5147
Mailing Address - Fax:512-746-2436
Practice Address - Street 1:115 DOUBLE CREEK DR
Practice Address - Street 2:12701 N I H 35
Practice Address - City:JARRELL
Practice Address - State:TX
Practice Address - Zip Code:76537-1114
Practice Address - Country:US
Practice Address - Phone:512-746-5147
Practice Address - Fax:512-746-2436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX584121251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX747957OtherMEDICARE PTAN