Provider Demographics
NPI:1891532172
Name:MARY CARE LLC
Entity type:Organization
Organization Name:MARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KEAUNA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:225-326-7314
Mailing Address - Street 1:19945 PECAN HILL DR
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-5363
Mailing Address - Country:US
Mailing Address - Phone:225-326-7314
Mailing Address - Fax:
Practice Address - Street 1:19945 PECAN HILL DR
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-5363
Practice Address - Country:US
Practice Address - Phone:225-326-7314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care