Healthcare Provider Details

I. General information

NPI: 1124210158
Provider Name (Legal Business Name): MARANATHA HOME CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 10/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1164 GOODLETTE ROAD
NAPLES FL
34102
US

IV. Provider business mailing address

360 HAMILTON AVE SUITE 120
WHITE PLAINS NY
10601-1811
US

V. Phone/Fax

Practice location:
  • Phone: 239-659-1122
  • Fax:
Mailing address:
  • Phone: 914-428-7722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number20737096
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number20737096
License Number StateFL

VIII. Authorized Official

Name: MR. GREGORY TURCHAN
Title or Position: CHIEF OPERATING OFFICER
Credential: MSW, MPA
Phone: 914-428-7722