MEDICARE: MARY'S HOMECARE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1336593029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARY'S HOMECARE LLC

Provider Business Mailing Address
First Line	:	2439 S CULPEPER ST
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22206-1028
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2439 S CULPEPER ST
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22206-1028
Country	:	US
Telephone Number	:	703-843-3502
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOSE CARLOS ASTORGA CASTRO
Credential	:
Telephone Number	:	703-843-3502

Provider Enumeration Date	:	04/19/2016
Last Update Date	:	04/19/2016

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