Provider Demographics
NPI:1982159224
Name:A MARVELOUS HOME COMMUNITY SUPPORT SERVICES
Entity type:Organization
Organization Name:A MARVELOUS HOME COMMUNITY SUPPORT SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARVA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-677-6954
Mailing Address - Street 1:119 PHEASANT LN
Mailing Address - Street 2:
Mailing Address - City:SEAGOVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75159-2501
Mailing Address - Country:US
Mailing Address - Phone:214-677-6954
Mailing Address - Fax:
Practice Address - Street 1:119 PHEASANT LN
Practice Address - Street 2:
Practice Address - City:SEAGOVILLE
Practice Address - State:TX
Practice Address - Zip Code:75159-2501
Practice Address - Country:US
Practice Address - Phone:214-677-6954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health