Healthcare Provider Details

I. General information

NPI: 1114645959
Provider Name (Legal Business Name): MARIE V DECADE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2908 15TH ST W
LEHIGH ACRES FL
33971-5442
US

IV. Provider business mailing address

2908 15TH ST W
LEHIGH ACRES FL
33971-5442
US

V. Phone/Fax

Practice location:
  • Phone: 239-692-1070
  • Fax:
Mailing address:
  • Phone: 239-692-1070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: