Healthcare Provider Details

I. General information

NPI: 1689521452
Provider Name (Legal Business Name): MARA VENTURE CAPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MCLEAN ST
HIGHLAND PARK MI
48203-3308
US

IV. Provider business mailing address

6311 HAGGERTY RD # 722
W BLOOMFIELD MI
48322-5031
US

V. Phone/Fax

Practice location:
  • Phone: 313-438-8788
  • Fax:
Mailing address:
  • Phone: 313-438-8788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TAMARA M EVANS
Title or Position: CEO
Credential:
Phone: 313-438-8788