MEDICARE: MARVELOUS1 CREATIONZ INC

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
2	385H00000X	Respite Care

General Provider Information

NPI Number	:	1952095531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARVELOUS1 CREATIONZ INC

Provider Business Mailing Address
First Line	:	1611 FITZWATER ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-2037
Country	:	US
Telephone Number	:	215-650-7292
Fax Number	:

Provider Business Practice Location Address
First Line	:	1207 DELAWARE AVE # 3337
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19806-4743
Country	:	US
Telephone Number	:	215-650-7292
Fax Number	:

Authorized Official
Title or Position	:	HEALTH, WELLNESS AND NUTRITION SPEC
Name	:	MARISA POOLER
Credential	:
Telephone Number	:	215-650-7292

Provider Enumeration Date	:	06/06/2023
Last Update Date	:	06/06/2023

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