MEDICARE: MARYE ASSISTANCE GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	320800000X	Mental Illness Community Based Residential Treatment Facility
3	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1275392110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARYE ASSISTANCE GROUP LLC

Provider Business Mailing Address
First Line	:	3699 NC-62
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27217
Country	:	US
Telephone Number	:	704-574-5921
Fax Number	:	336-223-7094

Provider Business Practice Location Address
First Line	:	3315 WRANGLER LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-2169
Country	:	US
Telephone Number	:	336-539-0765
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	PHYLLIS ALLEN
Credential	:
Telephone Number	:	704-574-5921

Provider Enumeration Date	:	03/14/2024
Last Update Date	:	03/14/2024

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Directions to “MARYE ASSISTANCE GROUP LLC ” Practice Location

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