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NPI Code Detail

MEDICARE: MARY'S HOMECARE LLC

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
1253Z00000XIn 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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Directions to “MARY'S HOMECARE LLC ” Practice Location

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