Healthcare Provider Details

I. General information

NPI: 1124897012
Provider Name (Legal Business Name): MARISATA CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2023
Last Update Date: 12/20/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MERRITT BLVD # 1307
TRUMBULL CT
06611-5435
US

IV. Provider business mailing address

35 HARRINGTON AVE UNIT 1307
SHREWSBURY MA
01545-5277
US

V. Phone/Fax

Practice location:
  • Phone: 860-234-7254
  • Fax: 888-422-3990
Mailing address:
  • Phone: 860-234-7254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. ZYNAB BAH
Title or Position: DIRECTOR
Credential:
Phone: 860-234-7254